PAIN IN FIBROMYALGIA AND DISCRIMINATIVE POWER OF THE INSTRUMENTS: VISUAL ANALOG SCALE, DOLORIMETRY AND THE MCGILL PAIN QUESTIONNAIRE

Objective: The aim of this study was to verify the discriminative power of the most widely used pain assessment instruments. Methods: The sample consisted of 279 subjects divided into Fibromyalgia Group (FM- 205 patients with fibromyalgia) and Control Group (CG-74 healthy subjects), mean age 49.29 +/- 10.76 years. Only 9 subjects were male, 6 in FM and 3 in CG. FM were outpatients from the Rheumatology Clinic of the University of Sao Paulo - Hospital das Clinicas (HCFMUSP); the CG included people accompanying patients and hospital staff with similar socio-demographic characteristics. Three instruments were used to assess pain: the McGill Pain Questionnaire (MPQ), the Visual Analog Scale (VAS), and the Dolorimetry, to measure pain threshold on tender points (generating the TP index). In order to assess the discriminative power of the instruments, the measurements obtained were submitted to descriptive analysis and inferential analysis using ROC Curve - sensibility (S), specificity (S I) and area under the curve (AUC) - and Contingence tables with Chi-square Test and odds ratio. Significance level was 0.05. Results: Higher sensibility, specificity and area under the curve was obtained by VAS (80%, 80% and 0.864, respectively), followed by Dolorimetry (S 77%, S177% and AUC 0.851), McGill Sensory (S 72%, S167% and AUC 0.765) and McGill Affective (S 69%, S1 67% and AUC 0.753). Conclusions: VAS presented the higher sensibility, specificity and AUC, showing the greatest discriminative power among the instruments. However, these values are considerably similar to those of Dolorimetry.

On a product formula for the Conley-Zelmder index of symplectic paths and its applications

Using invariance by fixed-endpoints homotopies and a generalized notion of symplectic Cayley transform, we prove a product formula for the Conley-Zehnder index of continuous paths with arbitrary endpoints in the symplectic group. We discuss two applications of the formula, to the metaplectic group and to periodic solutions of Hamiltonian systems.

Print quality study of newsprint : Further development of the laboratoryoffset press at PAPRO

A laboratory offset press has been developed over the last five years at PAPRO for testing print qualityon newsprint, as at present, there is no good way for the mills to test this issue. In this project a comparisonhas been made between a laboratory offset press and a commercial press to see if the laboratoryoffset press can be used as a reliable test method or if a further development is needed.To evaluate the method, similar papers have been printed in both presses and compared using imageanalysis techniques. All together eighteen samples were tested which is enough to give comparableresults. The print quality showed a high variation, the values from the laboratory offset press and thecommercial press were not following the same trends. At present time the laboratory offset press needsome further development before it can be used as a reliable test method for halftone prints. Even sosome conclusions were made.The newsprint that has been used came from Norske Skog Tasman Mill (Kawerau), since the otheraim of this project was to do a repeatability study of their three existing paper machines to distinguishpossible differences in the production. The paper samples were taken from each paper machine on sixdifferent dates to give a representative result. This also gave the opportunity to compare the machinesbetween themselves. Comparison between the machines shows that the wire side gives a better andmore even result than the topside on the prints from the laboratory offset press. According to the resultfrom the commercial press the wire side shows a higher degree of variability. Samples from papermachine 2 and 3 were less variable and had the lowest standard deviation of grey level for solid areas.This suggests that newsprints from PM 2 and PM 3 give a more even print quality with a better inkcoverage.

Emergency department triage scales and their components : a systematic review of the scientific evidence

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

Background There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. Methods SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Results Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832). Conclusions Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.

A simple demonstration of the existence of the jordan canonical form for any square matrix

All the demonstrations known to this author of the existence of the Jordan Canonical Form are somewhat complex - usually invoking the use of new spaces, and what not. These demonstrations are usually too difficult for an average Mathematics student to understand how he or she can obtain the Jordan Canonical Form for any square matrix. The method here proposed not only demonstrates the existence of such forms but, additionally, shows how to find them in a step by step manner. I do not claim that the following demonstration is in any way “elegant” (by the standards of elegance in fashion nowadays among mathematicians) but merely simple (undergraduate students taking a fist course in Matrix Algebra would understand how it works).

Sports administration: an examination of the competitive balance concept through european and brazilian domestic soccer leagues comparison

A questão do Equilíbrio Competitivo é um tema importante da economia dos esportes profissionais nos Estados Unidos e na Europa. Muitas pesquisas foram feitas para estabelecer os critérios mais relevantes para avaliar a competitividade das ligas profissionais de futebol. Esta pesquisa analisou a relevância do Equilíbrio Competitivo como determinante da competitividade comparando o Brasileirão Série A com as nove principais ligas na Europa (Bélgica, Inglaterra, Alemanha, Holanda, França, Itália, Portugal, Escócia e Espanha). A competitividade é a capacidade de uma empresa (um clube) ou de uma indústria de enfrentar a concorrência efetiva ou potencial. A medida da competitividade deve levar em consideração uma série de fatores importantes como a qualidade e a relação qualidade/preço, a gestão de recursos humanos e a organização empresarial. Esse trabalho visa demonstrar que, apesar da incerteza do resultado ter sido considerado por muito tempo como um fator positivo de atratividade/interesse dos fãs nos esportes, um campeonato equilibrado poderia ter um efeito insignificante, para não dizer desprezível sobre a competitividade das ligas de futebol a longo prazo. Os resultados mostraram que o aumento do Equilíbrio Competitivo pode ser relevante para os campeonatos mais fracos (Bélgica, Holanda, Portugal, Escócia), mas nao dos cincos melhores (Alemanha, Espanha, França, Inglaterra, Itália). Consequentemente, o Equilíbrio Competitivo deve ser contemplado como uma variável desprezível quanto à competitividade das ligas de futebol, apesar do interesse crescente pelo conceito na literatura. Baseado principalmente em pesquisas de Dell'Osso e Symanski (1991) e de Oughton e Michie (2004), o índice HHI (Herfindahl-Hirschman) tem sido utilizado para determinar o nível de concentração de 11 ligas de futebol estudadas. Uma revisão da literatura sobre administração de futebol e esportes foi realizada.

New evidence of the causal effect of family size on child quality in a developing country

This paper presents new evidence of the causal effect of family size on child quality in a developing-country context. We estimate the impact of family size on child labor and educational outcomes among Brazilian children and young adults by exploring the exogenous variation of family size driven by the presence of twins in the family. Using the Brazilian Census data for 1991, we nd that the exogenous increase in family size is positively related to labor force participation for boys and girls and to household chores for young women. We also and negative e ects on educational outcomes for boys and girls and negative impacts on human capital formation for young female adults. Moreover, we obtain suggestive evidence that credit and time constraints faced by poor families may explain the findings.

Employing the Components of the Human Development Index to Drive Resources to Educational Policies

A new form of composition of the indicators employed to generate the United Nations Human Development Index (HDI) is presented here. This form of composition is based on the assumption that random errors affect the measurement of each indicator. This assumption allows for replacing the vector of evaluations according to each indicator by vectors of probabilities of being the best or the worst according to such attribute. The probabilistic composition of such probabilities of preference according to each indicator into probabilities of being the best or the worst according to all of them generates indices that may unveil, on one hand, performances to be followed and, on the other hand, extreme conditions that an additive composition would hide. Differences between the results of application of the diverse forms of composition are examined in the case of the HDI and in the case of the districts version of the HDI employed to compare Brazilian municipalities. It is verified that the smallest correlation between the education.

Sustainability indexes: why join in? A study of the Corporate Sustainability Index (ISE) in Brazil

In the past decade, indicators have been created to assess the sustainability performance of companies listed in stock exchange markets. Academics and practitioners expect companies to benefit from being listed in such indexes, but evidence of value creation is still scarce. Since virtually all studies about the Corporate Sustainability Index (ISE) of the S~ ao Paulo Stock Exchange (Brazil) e the object of the present study e focused on the value of shares, we initially looked for answers in the finance theory. We collected secondary data about the financial and economic performance of companies forming the ISE's ‘theoretical portfolio’, as these kinds of indexes are also known. In a second stage, we sought additional motivations for companies to make efforts to be listed in the index. We collected additional data and interviewed representatives of key companies listed in the ISE, as well as industry leaders who chose not to participate in the selection process. The results support the main propositions of the institutional theory, as well as the ‘pays to be green’ literature e that the intangible value created by voluntary environmental initiatives, such as access to knowledge, new capabilities and reputational gain, better explain the efforts companies make to be listed in the ISE index

An analysis of the perceived service quality of hospitality industry in Rio de Janeiro through the SERVQUAL model: a multiple case study

Brazil is under political and financial crises where the end seems far away. Because of that, researchers argue that the hotel rooms offered by Rio de Janeiro, built to host the Olympic Games 2016, will be difficult to occupy after the event. It is then necessary for the hotels to understand how guests perceive the service quality in order to adapt to this new era. If guests’ perceptions meet or exceed their expectations, they will be satisfied and will probably return. Thus based on the SERVQUAL approach, this paper aims to study the impact of the service dimensions on the guests’ overall satisfaction at hotels of Rio de Janeiro. Two hotels were considered representative of the city in terms of service quality and customers’ profile. Interviews to the hotel managers were performed, and questionnaires to the guests were administered. Among the five SERVQUAL dimensions – Reliability, Tangibles, Responsiveness, Assurance, and Empathy – the Empathy dimension appears to be the only one that affects the guests’ overall satisfaction. The study could also identify that gender, country of residence, home country and family income have an impact on guests’ satisfaction. This study has no intention of generalization, but rather of refining the theory about services and the SERVQUAL model.

Improving the GNSS positioning stochastic model in the presence of ionospheric scintillation

Ionospheric scintillations are caused by time-varying electron density irregularities in the ionosphere, occurring more often at equatorial and high latitudes. This paper focuses exclusively on experiments undertaken in Europe, at geographic latitudes between similar to 50 degrees N and similar to 80 degrees N, where a network of GPS receivers capable of monitoring Total Electron Content and ionospheric scintillation parameters was deployed. The widely used ionospheric scintillation indices S4 and sigma(phi) represent a practical measure of the intensity of amplitude and phase scintillation affecting GNSS receivers. However, they do not provide sufficient information regarding the actual tracking errors that degrade GNSS receiver performance. Suitable receiver tracking models, sensitive to ionospheric scintillation, allow the computation of the variance of the output error of the receiver PLL (Phase Locked Loop) and DLL (Delay Locked Loop), which expresses the quality of the range measurements used by the receiver to calculate user position. The ability of such models of incorporating phase and amplitude scintillation effects into the variance of these tracking errors underpins our proposed method of applying relative weights to measurements from different satellites. That gives the least squares stochastic model used for position computation a more realistic representation, vis-a-vis the otherwise 'equal weights' model. For pseudorange processing, relative weights were computed, so that a 'scintillation-mitigated' solution could be performed and compared to the (non-mitigated) 'equal weights' solution. An improvement between 17 and 38% in height accuracy was achieved when an epoch by epoch differential solution was computed over baselines ranging from 1 to 750 km. The method was then compared with alternative approaches that can be used to improve the least squares stochastic model such as weighting according to satellite elevation angle and by the inverse of the square of the standard deviation of the code/carrier divergence (sigma CCDiv). The influence of multipath effects on the proposed mitigation approach is also discussed. With the use of high rate scintillation data in addition to the scintillation indices a carrier phase based mitigated solution was also implemented and compared with the conventional solution. During a period of occurrence of high phase scintillation it was observed that problems related to ambiguity resolution can be reduced by the use of the proposed mitigated solution.

Assessment of the quality of dna extracted by two techniques from Mycobacterium tuberculosis for fast molecular identification and genotyping

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)