Cross-cultural adaptation and assessment of the reliability and validity of the Core Outcome Measures Index (COMI) for the Brazilian-Portuguese language

The use of patient-orientated questionnaires is of utmost importance in assessing the outcome of spine surgery. Standardisation, using a common set of outcome measures, is essential to aid comparisons across studies/in registries. The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument validated for patients with spinal disorders. This study aimed to produce a Brazilian-Portuguese version of the COMI. A cross-cultural adaptation of the COMI into Brazilian-Portuguese was carried out using established guidelines. 104 outpatients with chronic LBP (> 3 months) were recruited from a Public Health Spine Medical Care Centre. They completed a questionnaire booklet containing the newly translated COMI, and other validated symptom-specific questionnaires: Oswestry Disability Index (ODI) and Roland Morris disability scale (RM), and a pain visual analogue scale. All patients completed a second questionnaire within 7-10 days to assess reproducibility. The COMI summary score displayed minimal floor and ceiling effects. On re-test, the responses for each individual domain of the COMI were within 1 category in 98% patients for the domain 'function', 96% for 'symptom-specific well-being', 97% for 'general quality of life', 99% for 'social disability' and 100% for 'work disability'. The intraclass correlation coefficients (ICC2,1) for COMI pain and COMI summary scores were 0.91-0.96, which compared favourably with the corresponding values for the RM (ICC, 0.99) and ODI (ICC, 0.98). The standard error of measurement for the COMI was 0.6, giving a "minimum detectable change" (MDC95%) of approximately 1.7 points i.e., the minimum change to be considered "real change" beyond measurement error. The COMI scores correlated as hypothesised (Rho, 0.4-0.8) with the other symptom-specific questionnaires. The reproducibility of the Brazilian-Portuguese version of the COMI was comparable to that of other language versions. The COMI scores correlated in the expected manner with existing but longer symptom-specific questionnaires suggesting good convergent validity for the COMI. The Brazilian-Portuguese COMI represents a valuable tool for Brazilian study-centres in future multicentre clinical studies and surgical registries.

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient's recovery as it causes clinical complications and could even lead to the patient's death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirao Preto, Sao Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26-91 years), were evaluated consecutively. An anamnesis was taken before the patient's participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation. Copyright (C) 2012 S. Karger AG, Basel

DeCS terminology and the new rules on orthography of Portuguese language: guidelines for an update

PURPOSE: To indicate orthographic changes to be used as a basic reference for professionals, researchers, doctors, teachers, students and users, which are directly linked and performing activities in health services in general, aimed at implementing the correct orthography in recovery and production of their scientific studies. METHODS: For data collection, were shown some examples of terminology DeCS (Descriptors in Health Science) analyzed according to the current spelling and compared with the Orthographic Vocabulary of Portuguese Language (VOLP). RESULTS: It was select and listed examples of key words and/or terms related to Health Sciences, which was compared to the respective rules of the Orthographic Agreement of Portuguese Language, and divided into three items: graphical accentuation, the non use of dieresis and exceptions and, the use of hyphen. CONCLUSION: This study show some guidelines for the orthographic alterations of the terms used by scientific community, according the new orthographic rules, contributing for the efficiency in the description of the documents and consequently in their recovery.

Antinuclear antibodies testing as a routine screening for systemic lupus erythematosus in patients presenting first-episode psychosis

Aims: This report discusses the use of antinuclear antibody (ANA) detection as a screening test for neuropsychiatry systemic lupus erythematosus (NPSLE) in patients presenting a first-episode psychosis. Methods: We reviewed the medical records of 85 patients admitted to an emergency service due to first-episode psychosis, during a 1-year period, for whom ANA detection was performed through an IFI HEp2 cell assay. ANA-positive patients were subsequently evaluated for autoantibodies and neuroimaging exams. Results: Three patients presented as ANA positive in the initial screening and further investigation confirmed NPSLE in two patients. The patients were treated with antipsychotics and cyclophosphamide pulses with satisfactory outcomes. Conclusion: Even though ANA detection is not specific, it is a low-cost procedure and could be an important screening test for NPSLE in the early-onset psychosis.

Reliability and construct validity of the karate-specific aerobic test

Chaabene, H, Hachana, Y, Franchini, E, Mkaouer, B, Montassar, M, and Chamari, K. Reliability and construct validity of the karate-specific aerobic test. J Strength Cond Res 26(12): 3454-3460, 2012-The aim of this study was to examine absolute and relative reliabilities and external responsiveness of the Karate-specific aerobic test (KSAT). This study comprised 43 male karatekas, 19 of them participated in the first study to establish test-retest reliability and 40, selected on the bases of their karate experience and level of practice, participated in the second study to identify external responsiveness of the KSAT. The latter group was divided into 2 categories: national-level group (G(n)) and regional-level group (Gr). Analysis showed excellent test-retest reliability of time to exhaustion (TE), with intraclass correlation coefficient ICC(3,1) >0.90, standard error of measurement (SEM) <5%: (3.2%) and mean difference (bias) +/- the 95% limits of agreement: -9.5 +/- 78.8 seconds. There was a significant difference between test-retest session in peak lactate concentration (Peak [La]) (9.12 +/- 2.59 vs. 8.05 +/- 2.67 mmol.L-1; p < 0.05) but not in peak heart rate (HRpeak) and rating of perceived exertion (RPE) (196 +/- 9 vs. 194 +/- 9 b.min(-1) and 7.6 +/- 0.93 vs. 7.8 +/- 1.15; p > 0.05), respectively. National-level karate athletes (1,032 +/- 101 seconds) were better than regional level (841 +/- 134 seconds) on TE performance during KSAT (p < 0.001). Thus, KSAT provided good external responsiveness. The area under the receiver operator characteristics curve was >0.70 (0.86; confidence interval 95%: 0.72-0.95). Significant difference was detected in Peak [La] between national- (6.09 +/- 1.78 mmol.L-1) and regional-level (8.48 +/- 2.63 mmol.L-1) groups, but not in HRpeak (194 +/- 8 vs. 195 +/- 8 b.min(-1)) and RPE (7.57 +/- 1.15 vs. 7.42 +/- 1.1), respectively. The result of this study indicates that KSAT provides excellent absolute and relative reliabilities. The KSAT can effectively distinguish karate athletes of different competitive levels. Thus, the KSAT may be suitable for field assessment of aerobic fitness of karate practitioners.

Using Machine Learning Classifiers to Assist Healthcare-Related Decisions: Classification of Electronic Patient Records

Surveillance Levels (SLs) are categories for medical patients (used in Brazil) that represent different types of medical recommendations. SLs are defined according to risk factors and the medical and developmental history of patients. Each SL is associated with specific educational and clinical measures. The objective of the present paper was to verify computer-aided, automatic assignment of SLs. The present paper proposes a computer-aided approach for automatic recommendation of SLs. The approach is based on the classification of information from patient electronic records. For this purpose, a software architecture composed of three layers was developed. The architecture is formed by a classification layer that includes a linguistic module and machine learning classification modules. The classification layer allows for the use of different classification methods, including the use of preprocessed, normalized language data drawn from the linguistic module. We report the verification and validation of the software architecture in a Brazilian pediatric healthcare institution. The results indicate that selection of attributes can have a great effect on the performance of the system. Nonetheless, our automatic recommendation of surveillance level can still benefit from improvements in processing procedures when the linguistic module is applied prior to classification. Results from our efforts can be applied to different types of medical systems. The results of systems supported by the framework presented in this paper may be used by healthcare and governmental institutions to improve healthcare services in terms of establishing preventive measures and alerting authorities about the possibility of an epidemic.

Testing the Performance of Fourteen Native Tropical Tree Species in Two Abandoned Pastures of the Lacandon Rainforest Region of Chiapas, Mexico

The rainforest of Mexico has been degraded and severely fragmented, and urgently require restoration. However, the practice of restoration has been limited by the lack of species-specific data on survival and growth responses to local environmental variation. This study explores the differential performance of 14 wet tropical early-, mid- or late-successional tree species that were grown in two abandoned pastures with contrasting land-use histories. After 18 months, seedling survival and growth of at least 7 of the 14 tree species studied were significantly higher in the site with a much longer history of land use (site 2). Saplings of the three early-successional species showed exceptional growth rates. However, differences in performance were noted in relation to the differential soil properties between the experimental sites. Mid-successional species generally showed slow growth rates but high seedling survival, whereas late-successional species exhibited poor seedling survival at both the study sites. Stepwise linear regressions revealed that the species integrated response index combining survivorship and growth measurements, was influenced mostly by differences in soil pH between the two abandoned pastures. Our results suggest that local environmental variation among abandoned pastures of contrasting land-use histories influences sapling survival and growth. Furthermore, the similarity of responses among species with the same successional status allowed us to make some preliminary site and species-specific silvicultural recommendations. Future field experiments should extend the number of species and the range of environmental conditions to identify site generalists or more narrowly adapted species, that we would call sensitive.

Organ-specific autoantibodies and autoimmune diseases in juvenile systemic lupus erythematosus and juvenile dermatomyositis patients

Objectives To our knowledge, no study assessed simultaneously a variety of organ-specific autoantibodies and the prevalence of organ-specific autoimmune diseases in juvenile systemic lupus erythematosus (ISLE) and juvenile dermatomyositis (JDM). Therefore, the purpose of this study was to evaluate organ-specific autoantibodies and autoimmune diseases in JSLE and JDM patients. Methods Forty-one JSLE and 41 JDM patients were investigated for autoantibodies associated with autoimmune hepatitis, primary biliary cirrhosis, type I diabetes mellitus (TIDM, autoimmune thyroiditis (AT), autoimmune gastritis and coeliac disease (CD). Patients with positive antibodies were investigated for the respective organ-specific autoimmune diseases. Results Mean age at diagnosis was higher in ISLE compared to JDM patients (10.3 +/- 3.4 vs. 7.3 +/- 3.1 years, p=0.0001). The frequencies of organ-specific autoantibodies were similar in JSLE and JDM patients (p>0.05). Of note, a high prevalence of TIDM and AT autoantibodies was observed in both groups (20% vs. 15%, p=0.77 and 24% vs. 15%, p=0.41; respectively). Higher frequencies of ANA (93% vs. 59%, p=0.0006), anti-dsDNA (61% vs. 2%, p<0.0001), anti-Ro, anti-Sm, anti-RNP, anti-La and IgG-aCL were observed in JSLE (p<0.05). Organ-specific autoimmune diseases were evidenced only in ISLE patients (24% vs. 0%, p=0.13). Two ISLE patients had TIDM associated with Hashimoto thyroiditis and another had subclinical thyroiditis. Another JSLE patient had CD diagnosis based on iron deficiency anaemia, anti-endomysial antibody, duodenal biopsy compatible to CD and response to a gluten-free diet. Conclusions Organ-specific diseases were observed solely in ISLE patients and required specific therapy. The presence of these antibodies recommends the evaluation of organ-specific diseases and a rigorous follow-up.

LALP: a language to program custom FPGA-based acceleration engines

Field-Programmable Gate Arrays (FPGAs) are becoming increasingly important in embedded and high-performance computing systems. They allow performance levels close to the ones obtained with Application-Specific Integrated Circuits, while still keeping design and implementation flexibility. However, to efficiently program FPGAs, one needs the expertise of hardware developers in order to master hardware description languages (HDLs) such as VHDL or Verilog. Attempts to furnish a high-level compilation flow (e.g., from C programs) still have to address open issues before broader efficient results can be obtained. Bearing in mind an FPGA available resources, it has been developed LALP (Language for Aggressive Loop Pipelining), a novel language to program FPGA-based accelerators, and its compilation framework, including mapping capabilities. The main ideas behind LALP are to provide a higher abstraction level than HDLs, to exploit the intrinsic parallelism of hardware resources, and to allow the programmer to control execution stages whenever the compiler techniques are unable to generate efficient implementations. Those features are particularly useful to implement loop pipelining, a well regarded technique used to accelerate computations in several application domains. This paper describes LALP, and shows how it can be used to achieve high-performance computing solutions.

Genome mapping and expression analyses of human intronic noncoding RNAs reveal tissue-specific patterns and enrichment in genes related to regulation of transcription

Abstract Background RNAs transcribed from intronic regions of genes are involved in a number of processes related to post-transcriptional control of gene expression. However, the complement of human genes in which introns are transcribed, and the number of intronic transcriptional units and their tissue expression patterns are not known. Results A survey of mRNA and EST public databases revealed more than 55,000 totally intronic noncoding (TIN) RNAs transcribed from the introns of 74% of all unique RefSeq genes. Guided by this information, we designed an oligoarray platform containing sense and antisense probes for each of 7,135 randomly selected TIN transcripts plus the corresponding protein-coding genes. We identified exonic and intronic tissue-specific expression signatures for human liver, prostate and kidney. The most highly expressed antisense TIN RNAs were transcribed from introns of protein-coding genes significantly enriched (p = 0.002 to 0.022) in the 'Regulation of transcription' Gene Ontology category. RNA polymerase II inhibition resulted in increased expression of a fraction of intronic RNAs in cell cultures, suggesting that other RNA polymerases may be involved in their biosynthesis. Members of a subset of intronic and protein-coding signatures transcribed from the same genomic loci have correlated expression patterns, suggesting that intronic RNAs regulate the abundance or the pattern of exon usage in protein-coding messages. Conclusion We have identified diverse intronic RNA expression patterns, pointing to distinct regulatory roles. This gene-oriented approach, using a combined intron-exon oligoarray, should permit further comparative analysis of intronic transcription under various physiological and pathological conditions, thus advancing current knowledge about the biological functions of these noncoding RNAs.

Questionnaire for monitoring auditory and language development in the first year of life

Purpose: To validate a monitoring questionnaire about hearing and language development applied by community health agents in the first year of life. Methods: Seventy six community health agents, previously trained on infant hearing health, administered a questionnaire to the families of 304 children with ages from 0 to 1 year. The questionnaire contains questions regarding hearing and language development and, for all age groups, the question “Does your child hear well?” was presented. The validity of the questionnaire was assessed by analyzing false positive and false negative rates of the identified children. A double-blind study was conducted so that all children assessed by the questionnaire were submitted to hearing evaluation performed by audiologists. Results: Four children (1.32%) were diagnosed with sensorineural hearing loss (two unilateral), and 69 (22.7%) with conductive hearing loss. The monitoring questionnaire showed specificity of 96% and sensitivity of 67%, with a false-negative rate of 33% for not identifying the unilateral hearing loss, and a false-positive rate of 4%. Conclusion: The questionnaire used has shown to be feasible and relevant to actions of the community health agents of the Family Health Strategy program, with high specificity and moderate sensitivity. The use of the validated instrument should be considered to complement Newborn Hearing Screening Programs, in order to identify late onset or acquired hearing loss.

Academic and clinical preparation in speech-language pathology and audiology: a global training consortium

ABSTRACT: Purpose: To describe a research-based global curriculum in speech-language pathology and audiology that is part of a funded cross-linguistic consortium among 2 U.S. and 2 Brazilian universities. Method: The need for a global curriculum in speechlanguage pathology and audiology is outlined, and different funding sources are identified to support development of a global curriculum. The U.S. Department of Education’s Fund for the Improvement of Post-Secondary Education (FIPSE), in conjunction with the Brazilian Ministry of Education (Fundacao Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior; CAPES), funded the establishment of a shared research curriculum project, “Consortium for Promoting Cross-Linguistic Understanding of Communication Disabilities in Children” for East Tennessee State University and the University of Northern Iowa and 2 Brazilian universities (Universidade Federal de Santa Maria and Universidade de São Paulo-Baurú). Results: The goals and objectives of the research-based global curriculum are summarized, and a description of an Internet-based course, “Different Languages, One World,” is provided Conclusion: Partnerships such as the FIPSE–CAPES consortium provide a foundation for training future generations of globally and research-prepared practitioners in speechlanguage pathology and audiology.

Hearing loss and acquired immune deficiency syndrome: systematic review

PURPOSE: To investigate the occurrence of hearing loss in individuals with HIV/AIDS and their characterization regarding type and degree. RESEARCH STRATEGY: It was conducted a systematic review of the literature found on the electronic databases PubMed, EMBASE, ADOLEC, IBECS, Web of Science, Scopus, Lilacs and SciELO. SELECTION CRITERIA: The search strategy was directed by a specific question: "Is hearing loss part of the framework of HIV/AIDS manifestations?", and the selection criteria of the studies involved coherence with the proposed theme, evidence levels 1, 2 or 3, and language (Portuguese, English and Spanish). DATA ANALYSIS: We found 698 studies. After an analysis of the title and abstract, 91 were selected for full reading. Out of these, 38 met the proposed criteria and were included on the review. RESULTS: The studies reported presence of conductive, sensorineural, and mixed hearing loss, of variable degrees and audiometric configurations, in addition to tinnitus and vestibular disorders. The etiology can be attributed to opportunistic infections, ototoxic drugs or to the action of virus itself. The auditory evoked potentials have been used as markers of neurological alterations, even in patients with normal hearing. CONCLUSION: HIV/AIDS patients may present hearing loss. Thus, programs for prevention and treatment of AIDS must involve actions aimed at auditory health.

A holistic approach to model-based testing of Web service compositions

The behavior of composed Web services depends on the results of the invoked services; unexpected behavior of one of the invoked services can threat the correct execution of an entire composition. This paper proposes an event-based approach to black-box testing of Web service compositions based on event sequence graphs, which are extended by facilities to deal not only with service behavior under regular circumstances (i.e., where cooperating services are working as expected) but also with their behavior in undesirable situations (i.e., where cooperating services are not working as expected). Furthermore, the approach can be used independently of artifacts (e.g., Business Process Execution Language) or type of composition (orchestration/choreography). A large case study, based on a commercial Web application, demonstrates the feasibility of the approach and analyzes its characteristics. Test generation and execution are supported by dedicated tools. Especially, the use of an enterprise service bus for test execution is noteworthy and differs from other approaches. The results of the case study encourage to suggest that the new approach has the power to detect faults systematically, performing properly even with complex and large compositions. Copyright © 2012 John Wiley & Sons, Ltd.

Interactive application in spanish sign language for a public transport environment

[ES] En este trabajo se presenta el diseño de una herramienta multimedia que traduce a la lengua de signos españolas los mensajes de avisos que puede proporcionar un sistema de megafonía. El objetivo del trabajo es proporcionar una herramienta que mejore la inclusión social de las personas con discapacidades auditivas. Con este propósito, se han seleccionado el entorno y los mensajes de audio habituales en un aeropuerto para desarrollar este proyecto piloto. Por último, los audios se han traducido a lengua de signos españolas sintetizando un avatar usando la técnica de animación de rotoscopía a partir de la grabación en vídeo de un traductor. Los resultados finales han sido evaluados por personas sordas.