Timely follow-up of abnormal diagnostic imaging test results in an outpatient setting: are electronic medical records achieving their potential?

BACKGROUND: Given the fragmentation of outpatient care, timely follow-up of abnormal diagnostic imaging results remains a challenge. We hypothesized that an electronic medical record (EMR) that facilitates the transmission and availability of critical imaging results through either automated notification (alerting) or direct access to the primary report would eliminate this problem. METHODS: We studied critical imaging alert notifications in the outpatient setting of a tertiary care Department of Veterans Affairs facility from November 2007 to June 2008. Tracking software determined whether the alert was acknowledged (ie, health care practitioner/provider [HCP] opened the message for viewing) within 2 weeks of transmission; acknowledged alerts were considered read. We reviewed medical records and contacted HCPs to determine timely follow-up actions (eg, ordering a follow-up test or consultation) within 4 weeks of transmission. Multivariable logistic regression models accounting for clustering effect by HCPs analyzed predictors for 2 outcomes: lack of acknowledgment and lack of timely follow-up. RESULTS: Of 123 638 studies (including radiographs, computed tomographic scans, ultrasonograms, magnetic resonance images, and mammograms), 1196 images (0.97%) generated alerts; 217 (18.1%) of these were unacknowledged. Alerts had a higher risk of being unacknowledged when the ordering HCPs were trainees (odds ratio [OR], 5.58; 95% confidence interval [CI], 2.86-10.89) and when dual-alert (>1 HCP alerted) as opposed to single-alert communication was used (OR, 2.02; 95% CI, 1.22-3.36). Timely follow-up was lacking in 92 (7.7% of all alerts) and was similar for acknowledged and unacknowledged alerts (7.3% vs 9.7%; P = .22). Risk for lack of timely follow-up was higher with dual-alert communication (OR, 1.99; 95% CI, 1.06-3.48) but lower when additional verbal communication was used by the radiologist (OR, 0.12; 95% CI, 0.04-0.38). Nearly all abnormal results lacking timely follow-up at 4 weeks were eventually found to have measurable clinical impact in terms of further diagnostic testing or treatment. CONCLUSIONS: Critical imaging results may not receive timely follow-up actions even when HCPs receive and read results in an advanced, integrated electronic medical record system. A multidisciplinary approach is needed to improve patient safety in this area.

Assessing the function of the fronto-parietal attention network: Insights from resting-state fMRI and the attentional network test

In the recent past, various intrinsic connectivity networks (ICN) have been identified in the resting brain. It has been hypothesized that the fronto-parietal ICN is involved in attentional processes. Evidence for this claim stems from task-related activation studies that show a joint activation of the implicated brain regions during tasks that require sustained attention. In this study, we used functional magnetic resonance imaging (fMRI) to demonstrate that functional connectivity within the fronto-parietal network at rest directly relates to attention. We applied graph theory to functional connectivity data from multiple regions of interest and tested for associations with behavioral measures of attention as provided by the attentional network test (ANT), which we acquired in a separate session outside the MRI environment. We found robust statistical associations with centrality measures of global and local connectivity of nodes within the network with the alerting and executive control subfunctions of attention. The results provide further evidence for the functional significance of ICN and the hypothesized role of the fronto-parietal attention network. Hum Brain Mapp , 2013. © 2013 Wiley Periodicals, Inc.

Hydrogeological investigations in the upper Ouémé catchment in Benin, West Africa

The scope of this PhD thesis was the hydrogeological conceptualisation of the Upper Ouémé river catchment in Benin. The study area exceeds 14,500 km**2 and is underlain by a crystalline basement. At this setting the typical sequence of aquifers - a regolith aquifer at the top and a fractured bedrock aquifer at the bottom - is encountered, which is found in basement areas all over Africa and elsewhere in the world. The chosen regional approach revealed important information about the hydrochemistry and hydrogeology of this catchment. Based on the regional conceptual model a numerical groundwater flow model was designed. The numerical model was used to estimate the impact of climate change on the regional groundwater resources. This study was realised within the framework of the German interdisciplinary research project IMPETUS (English translation: "Integrated approach to the efficient management of scarce water resources in West Africa"), which is jointly managed by the German universities of Bonn and Cologne. Since the year 2000 the Upper Ouémé catchment was the principal target for investigations into the relevant processes of the regional water cycle. A first study from 2000 to 2003 (Fass, 2004, http://nbn-resolving.de/urn:nbn:de:hbz:5n-03849) focused on the hydrogeology of a small local catchment (~30 km**2). In the course of this thesis five field campaigns were underdone from the year 2004 to 2006. In the beginning of 2004 a groundwater monitoring net was installed based on 12 automatic data loggers. Manual piezometric measurements and the sampling of groundwater and surface water were realised for each campaign throughout the whole study area. Water samples were analysed for major ions, for a choice of heavy metals and for their composition by deuterium, oxygen-18 and tritium. The numerical model was performed with FEFLOW. The hydraulic and hydrochemical characteristics were described for the regolith aquifer and the bedrock aquifer. The regolith aquifer plays the role of the groundwater stock with low conductivity while the fractures of the bedrock may conduct water relatively fast towards extraction points. Flow in fractures of the bedrock depends on the connectivity of the fracture network which might be of local to subregional importance. Stable isotopes in combination with hydrochemistry proved that recharge occurs on catchment scale and exclusively by precipitation. Influx of groundwater from distant areas along dominant structures like the Kandi fault or from the Atacora mountain chain is excluded. The analysis of tritium in groundwater from different depths revealed the interesting fact of the strongly rising groundwater ages. Bedrock groundwater may possibly be much older than 50 years. Equilibrium phases of the silicate weathering products kaolinite and montmorillonite showed that the deeper part of the regolith aquifer and the bedrock aquifer feature either stagnant or less mobile groundwater while the shallow aquifer level is influenced by seasonal groundwater table fluctuations. The hydrochemical data characterised this zone by the progressive change of the hydrochemical facies of recently infiltrated rainwater on its flow path into deeper parts of the aquifers. Surprisingly it was found out that seasonal influences on groundwater hydrochemistry are minor, mainly because they affect only the groundwater levels close to the surface. The transfer of the hydrogeological features of the Upper Ouémé catchment into a regional numerical model demanded a strong simplification. Groundwater tables are a reprint of the general surface morphology. Pumping or other types of groundwater extraction would have only very local impact on the available groundwater resources. It was possible to integrate IMPETUS scenario data into the groundwater model. As a result it was shown that the impact of climate change on the groundwater resources until the year 2025 under the given conditions will be negligible due to the little share of precipitation needed for recharge and the low water needs for domestic use. Reason for concern is the groundwater quality on water points in the vicinity of settlements because of contamination by human activities as shown for the village of Dogué. Nitrate concentrations achieved in many places already alerting levels. Health risks from fluoride or heavy metals were excluded for the Upper Ouémé area.

Aplicación de técnicas de inteligencia artificial a la predicción de contaminantes atmosféricos

Abstract Air pollution is a big threat and a phenomenon that has a specific impact on human health, in addition, changes that occur in the chemical composition of the atmosphere can change the weather and cause acid rain or ozone destruction. Those are phenomena of global importance. The World Health Organization (WHO) considerates air pollution as one of the most important global priorities. Salamanca, Gto., Mexico has been ranked as one of the most polluted cities in this country. The industry of the area led to a major economic development and rapid population growth in the second half of the twentieth century. The impact in the air quality is important and significant efforts have been made to measure the concentrations of pollutants. The main pollution sources are locally based plants in the chemical and power generation sectors. The registered concerning pollutants are Sulphur Dioxide (SO2) and particles on the order of ∼10 micrometers or less (PM10). The prediction in the concentration of those pollutants can be a powerful tool in order to take preventive measures such as the reduction of emissions and alerting the affected population. In this PhD thesis we propose a model to predict concentrations of pollutants SO2 and PM10 for each monitoring booth in the Atmospheric Monitoring Network Salamanca (REDMAS - for its spanish acronym). The proposed models consider the use of meteorological variables as factors influencing the concentration of pollutants. The information used along this work is the current real data from REDMAS. In the proposed model, Artificial Neural Networks (ANN) combined with clustering algorithms are used. The type of ANN used is the Multilayer Perceptron with a hidden layer, using separate structures for the prediction of each pollutant. The meteorological variables used for prediction were: Wind Direction (WD), wind speed (WS), Temperature (T) and relative humidity (RH). Clustering algorithms, K-means and Fuzzy C-means, are used to find relationships between air pollutants and weather variables under consideration, which are added as input of the RNA. Those relationships provide information to the ANN in order to obtain the prediction of the pollutants. The results of the model proposed in this work are compared with the results of a multivariate linear regression and multilayer perceptron neural network. The evaluation of the prediction is calculated with the mean absolute error, the root mean square error, the correlation coefficient and the index of agreement. The results show the importance of meteorological variables in the prediction of the concentration of the pollutants SO2 and PM10 in the city of Salamanca, Gto., Mexico. The results show that the proposed model perform better than multivariate linear regression and multilayer perceptron neural network. The models implemented for each monitoring booth have the ability to make predictions of air quality that can be used in a system of real-time forecasting and human health impact analysis. Among the main results of the development of this thesis we can cite: A model based on artificial neural network combined with clustering algorithms for prediction with a hour ahead of the concentration of each pollutant (SO2 and PM10) is proposed. A different model was designed for each pollutant and for each of the three monitoring booths of the REDMAS. A model to predict the average of pollutant concentration in the next 24 hours of pollutants SO2 and PM10 is proposed, based on artificial neural network combined with clustering algorithms. Model was designed for each booth of the REDMAS and each pollutant separately. Resumen La contaminación atmosférica es una amenaza aguda, constituye un fenómeno que tiene particular incidencia sobre la salud del hombre. Los cambios que se producen en la composición química de la atmósfera pueden cambiar el clima, producir lluvia ácida o destruir el ozono, fenómenos todos ellos de una gran importancia global. La Organización Mundial de la Salud (OMS) considera la contaminación atmosférica como una de las más importantes prioridades mundiales. Salamanca, Gto., México; ha sido catalogada como una de las ciudades más contaminadas en este país. La industria de la zona propició un importante desarrollo económico y un crecimiento acelerado de la población en la segunda mitad del siglo XX. Las afectaciones en el aire son graves y se han hecho importantes esfuerzos por medir las concentraciones de los contaminantes. Las principales fuentes de contaminación son fuentes fijas como industrias químicas y de generación eléctrica. Los contaminantes que se han registrado como preocupantes son el Bióxido de Azufre (SO2) y las Partículas Menores a 10 micrómetros (PM10). La predicción de las concentraciones de estos contaminantes puede ser una potente herramienta que permita tomar medidas preventivas como reducción de emisiones a la atmósfera y alertar a la población afectada. En la presente tesis doctoral se propone un modelo de predicción de concentraci ón de los contaminantes más críticos SO2 y PM10 para cada caseta de monitorización de la Red de Monitorización Atmosférica de Salamanca (REDMAS). Los modelos propuestos plantean el uso de las variables meteorol ógicas como factores que influyen en la concentración de los contaminantes. La información utilizada durante el desarrollo de este trabajo corresponde a datos reales obtenidos de la REDMAS. En el Modelo Propuesto (MP) se aplican Redes Neuronales Artificiales (RNA) combinadas con algoritmos de agrupamiento. La RNA utilizada es el Perceptrón Multicapa con una capa oculta, utilizando estructuras independientes para la predicción de cada contaminante. Las variables meteorológicas disponibles para realizar la predicción fueron: Dirección de Viento (DV), Velocidad de Viento (VV), Temperatura (T) y Humedad Relativa (HR). Los algoritmos de agrupamiento K-means y Fuzzy C-means son utilizados para encontrar relaciones existentes entre los contaminantes atmosféricos en estudio y las variables meteorológicas. Dichas relaciones aportan información a las RNA para obtener la predicción de los contaminantes, la cual es agregada como entrada de las RNA. Los resultados del modelo propuesto en este trabajo son comparados con los resultados de una Regresión Lineal Multivariable (RLM) y un Perceptrón Multicapa (MLP). La evaluación de la predicción se realiza con el Error Medio Absoluto, la Raíz del Error Cuadrático Medio, el coeficiente de correlación y el índice de acuerdo. Los resultados obtenidos muestran la importancia de las variables meteorológicas en la predicción de la concentración de los contaminantes SO2 y PM10 en la ciudad de Salamanca, Gto., México. Los resultados muestran que el MP predice mejor la concentración de los contaminantes SO2 y PM10 que los modelos RLM y MLP. Los modelos implementados para cada caseta de monitorizaci ón tienen la capacidad para realizar predicciones de calidad del aire, estos modelos pueden ser implementados en un sistema que permita realizar la predicción en tiempo real y analizar el impacto en la salud de la población. Entre los principales resultados obtenidos del desarrollo de esta tesis podemos citar: Se propone un modelo basado en una red neuronal artificial combinado con algoritmos de agrupamiento para la predicción con una hora de anticipaci ón de la concentración de cada contaminante (SO2 y PM10). Se diseñó un modelo diferente para cada contaminante y para cada una de las tres casetas de monitorización de la REDMAS. Se propone un modelo de predicción del promedio de la concentración de las próximas 24 horas de los contaminantes SO2 y PM10, basado en una red neuronal artificial combinado con algoritmos de agrupamiento. Se diseñó un modelo para cada caseta de monitorización de la REDMAS y para cada contaminante por separado.

Desarrollo e implementación de espacios verdes inteligentes basados en tecnologías M2M

En esta memoria se muestra el desarrollo del proyecto realizado para la creación de un sistema implantado en espacios verdes de las ciudades. A partir del estudio previo del mercado en torno a las Smart Cities se plantea el desarrollo de un sistema que mejore la sostenibilidad, la eficiencia y la seguridad de sistemas de riego, de medidores de la calidad del aire o estaciones meteorológicas instalados en los espacios verdes y jardines de las ciudades. Sirve de demostrador de cómo mejorar la eficiencia del consumo de agua y energía, además de añadir la funcionalidad de monitorizar la información recibida por sensores instalados en estos espacios en tiempo real a través del sistema desarrollado. La finalidad de este proyecto es la de crear un demostrador que sirva de ejemplo e inspiración para proyectos futuros que se basen en las mismas herramientas que son ofrecidas por Telefónica. El demostrador consiste en el control, gestión y mantenimiento de estos espacios, de modo que se pueda realizar un control y un mantenimiento de los dispositivos y sensores instalados en cada localización y la monitorización de la información suministrada por dichos elementos gracias a la plataforma M2M mediante los simuladores de sensores que ofrece Telefónica para demostraciones. Desde la aplicación, y mediante tecnologías REST y WEB, se realiza la comunicación con los elementos ofrecidos por Telefónica. La información de los sensores almacenada se muestra mediante la creación de informes y gráficas, mostrando la información recibida de los distintos parámetros de medida posibles, como son consumo de agua, temperatura, humedad y medidas de calidad del aire entre otras disponibles. Además, hay un espacio disponible para localizar y gestionar los dispositivos de los que se disponga existiendo la posibilidad de creación de alertas y avisos en función de lo que requiera el usuario. La solución creada como demostrador tiene dos componentes realizados por el estudiante. El primer componente desarrollado consiste en una plataforma web mediante la cual se pueda gestionar en tiempo real los dispositivos instalados en estos espacios verdes, su localización, realizar informes y gráficas, mostrando la información recibida de los sensores y la gestión de reglas para controlar valores límites impuestos por el usuario. El segundo componente es un servicio REST al cual se accede desde la plataforma web creada en el anterior componente y realiza la comunicación con los servicios ofrecidos por Telefónica y la identificación del proveedor del servicio con Telefónica a través del uso de un certificado privado. Además, este componente lleva a cabo la gestión de usuarios, mediante la creación de un servicio de autenticación para limitar los recursos ofrecidos en el servicio REST a determinados usuarios. ABSTRACT. In this memorandum the development of the project carried out for the creation of an implanted into green spaces in cities system is shown. From the previous study of the market around the Smart Cities it arise development of a system to improve the sustainability, efficiency and safety of irrigation systems, meter air quality and green spaces installed weather stations and gardens of cities. It serves as a demonstrator of how to improve the efficiency of water and energy consumption, as well as adding functionality to monitor the information received by sensors installed in these spaces in real time through the system developed. The purpose of this project is to create a demonstrator to provide an example and an inspiration for future projects based on the same tools that are provided by Telefónica. The demonstrator consists of control, management and maintenance of these spaces, so that it can carry out checks and maintenance of devices and sensors installed at each location and monitoring of the information provided by these elements through the M2M platform sensor simulators offered by Telefónica. From the application, and using REST and Web technologies, communication with the items provided by Telefónica is performed. Information stored sensors is shown by creating reports and graphs showing information received from the different parameters as possible, such as water consumption, temperature, humidity and air quality measures among others available. Addition there is an available space to locate and manage devices which becomes available with the possibility of creating alerting and warnings based on what the user requires. The solution created as a demonstrator has two components made by the student. The first component consists of a developed web platform through which to manage real-time devices installed in these green spaces, displaying the information received from the sensors and management rules to control limit values by the user. The second component is a REST service which is accessible from the web platform created in the previous component and performs communication with the services provided by Telefónica and the identification of the service provider with Telefónica through the use of a private certificate. In addition, this component performs user management, by creating an authentication service to restrict the resources available on the REST service to certain users.

Detección de usuarios vulnerables de la carretera mediante smartphones

Hoy en día, los teléfonos inteligentes forman parte de la vida de la mayoría de las personas, desde los usuarios más jóvenes a los más adultos, demostrando su utilidad en distintas actividades y con objetivos diferentes, como pueden ser por cuestiones de trabajo, estudio, ocio o incluso seguridad. Con respecto a este último aspecto se ha detectado una utilidad práctica para el colectivo de peatones. Según la DGT el 48% de los fallecidos en accidentes urbanos fueron peatones. Con el objetivo de disminuir drásticamente esta cifra se ideó un proyecto que incrementara la seguridad del peatón avisándole de los potenciales peligros que pudieran afectarle. Para ello era necesario que los vehículos de su entorno, de alguna manera, informaran de su posición y trayectoria y que un software analizara esta información para detectar potenciales situaciones de riesgo. Dada la versatilidad y la ubicuidad de los teléfonos inteligentes (prácticamente la mayoría de personas lo llevan continuamente) se decidió utilizarlos como soporte para el procesado de esta información. Para especificar la funcionalidad de la aplicación se han definido una serie de historias de usuario. La aplicación desarrollada solicita a los vehículos la información necesaria para calcular sus trayectorias y comprueba si pueden suponer algún peligro para el peatón, alertándole en ese caso. ABSTRACT Nowadays, smartphones are part of most people’s life, from the youngest to the oldest users, showing their usefulness in different activities and with different objectives, such as labour issues, studies, leisure or even safety. With respect to this last point, it has been detected a practical utility for pedestrians. According to the DGT, the 48% of the deceased due to urban accidents were pedestrians. In order to slash this figure, it was devised a project to increase pedestrian safety warning him of potential hazards that could affect him. To do so, it was needed that vehicles around him report their position and trajectory, and that a software analyse this information to detect potential risk situations. Due to the versatility and ubiquity of smartphones (practically the majority of people carries them continuously), it was decided to use them as support for the processing of this information. To specify the application functionality, it has been defined a set of user stories. The application developed requests the information needed to the vehicles to calculate their trajectories and checks if they may constitute a hazard for pedestrians, alerting them if that is the case.

Nerve growth factor in the anterior pituitary: localization in mammotroph cells and cosecretion with prolactin by a dopamine-regulated mechanism.

Nerve growth factor (NGF) is well characterized for its neurotrophic actions on peripheral sensory and sympathetic neurons and on central cholinergic neurons of the basal forebrain. Recent evidence, however, has shown high levels of NGF to be present in a variety of biological fluids after inflammatory and autoimmune responses, suggesting that NGF is a mediator of immune interactions. Increased NGF serum levels have been reported in both humans and experimental animal models of psychological and physical stress, thus implicating NGF in neuroendocrine interactions as well. The possible source(s) and the regulatory mechanisms involved in the control of serum NGF levels, however, still remain to be elucidated. We now report the presence of both NGF gene transcripts and protein in the anterior pituitary. Immunofluorescence analysis indicated that hypophysial NGF is selectively localized in mammotroph cells and stored in secretory granules. NGF is cosecreted with prolactin from mammotroph cells by a neurotransmitter-dependent mechanism that can be pharmacologically regulated. Activation of the dopamine D2 receptor subtype, which physiologically controls prolactin release, resulted in a complete inhibition of vasoactive intestinal peptide-stimulated NGF secretion in vitro, whereas the specific D2 antagonist (-)-sulpiride stimulated NGF secretion in vivo, suggesting that the anterior pituitary is a possible source of circulating NGF. Given the increased NGF serum levels in stressful conditions and the newly recognized immunoregulatory function of this protein, NGF, together with prolactin, may thus be envisaged as an immunological alerting signal under neuronal control.

Europe's economic challenges and the importance of ideas and innovation. CHALLENGE EUROPE Issue 22 - Challenges and new beginnings: Priorities for the EU's new leadership, September 2014.

How will we Europeans earn our living in 20 or 30 years' time? And how can it be done, while remaining true to our values of fairness, freedom and solidarity? These fundamental questions predate the financial crisis and will still be with us once we have fully overcome it. Of all the groups in society, business leaders are probably most keenly aware of the challenge posed by globalisation. They have their finger on the pulse of global economic activity and keep alerting me that Europe is losing out. The trade unions, generally more focused on the economy's demand side, regularly call for more (public) investment. Their leadership remains highly committed to Europe but they can sense a rise of Euro-scepticism among their members. We must, and can bring these two narratives together. Yes, global change is relentless and our societies must adapt, but we can also preserve what makes Europe such a special place: a unique combination of relative prosperity, solidarity, individual freedoms, and security. This challenge was always on my mind.

Atitudes dos pais perante a criança com febre

Enquadramento – A fobia da febre contínua a subsistir na atualidade, levando muitos pais a ficar ansiosos perante a febre no seu filho, refletindo-se em atitudes menos adequadas. Objetivos – Identificar se as variáveis sociodemográficas se repercutem nas atitudes dos pais/acompanhantes face à criança com febre; analisar se as variáveis contextuais da criança interferem nas atitudes dos pais/acompanhantes face à criança com febre; averiguar se as variáveis fontes de informação sobre a febre interferem nas atitudes dos pais/acompanhantes face à criança com febre. Material e Método – Estudo quantitativo, transversal, descritivo e correlacional. Recorreu-se ao questionário de caracterização sociodemográfica, variáveis clínicas, fontes de informação, conhecimento e atitudes perante a criança com febre. A amostra é do tipo não probabilística por conveniência, constituída por 360 pais/acompanhantes de crianças na consulta de Vigilância de Saúde Infantil e Juvenil. Resultados – Amostra é maioritariamente feminina (51.7%), sendo as mulheres, em média (M=34.78 anos .7.976 anos), mais velhas comparativamente aos homens. As principais fontes de informação sobre a febre foram o médico de família, o enfermeiro, os familiares e a experiência própria. O sexo, a idade, a zona de residência e as habilitações literárias são variáveis que interferem nas atitudes dos participantes perante a criança com febre. Existe uma probabilidade de 63.9% de atitudes não adequadas perante a criança com febre. Conclusão: Os resultados indicam que as atitudes da maioria dos pais/acompanhantes face à criança com febre são desadequadas. O que justifica que os pais/acompanhantes têm de ser mais esclarecidos, fazendo-se uma contextualização e desdramatização sobre o significado da febre, realçando aos pais a sua importância como mecanismo protetor do organismo no combate à infeção, alertando-os para os sinais de alarme que justificam a observação profissional atempada e para a adoção de atitudes adequadas. Palavras-chave: Febre; Criança; Pais; Atitudes.

Prevalence of the use of cancer related self-tests by members of the public:A community survey

Background: Self-tests are those where an individual can obtain a result without recourse to a health professional, by getting a result immediately or by sending a sample to a laboratory that returns the result directly. Self-tests can be diagnostic, for disease monitoring, or both. There are currently tests for more than 20 different conditions available to the UK public, and self-testing is marketed as a way of alerting people to serious health problems so they can seek medical help. Almost nothing is known about the extent to which people self-test for cancer or why they do this. Self-tests for cancer could alter perceptions of risk and health behaviour, cause psychological morbidity and have a significant impact on the demand for healthcare. This study aims to gain an understanding of the frequency of self-testing for cancer and characteristics of users. Methods: Cross-sectional survey. Adults registered in participating general practices in the West Midlands Region, will be asked to complete a questionnaire that will collect socio-demographic information and basic data regarding previous and potential future use of self-test kits. The only exclusions will be people who the GP feels it would be inappropriate to send a questionnaire, for example because they are unable to give informed consent. Freepost envelopes will be included and non-responders will receive one reminder. Standardised prevalence rates will be estimated. Discussion: Cancer related self-tests, currently available from pharmacies or over the Internet, include faecal occult blood tests (related to bowel cancer), prostate specific antigen tests (related to prostate cancer), breast cancer kits (self examination guide) and haematuria tests (related to urinary tract cancers). The effect of an increase in self-testing for cancer is unknown but may be considerable: it may affect the delivery of population based screening programmes; empower patients or cause unnecessary anxiety; reduce costs on existing healthcare services or increase demand to investigate patients with positive test results. It is important that more is known about the characteristics of those who are using self-tests if we are to determine the potential impact on health services and the public. © 2006 Wilson et al; licensee BioMed Central Ltd.

Past, Present, and Future: The Food Service Industry and Its Changes

In the article - Past, Present, and Future: The Food Service Industry and Its Changes - by Brother Herman E. Zaccarelli, International Director, Restaurant, Hotel and Institutional Management Institute at Purdue University, Brother Zaccarelli initially states: “Educators play an important role in the evolution of the food service industry. The author discusses that evolution and suggests how educators can be change agents along with management in that evolutionary progression.” The author goes on to wax philosophically, as well as speak generically about the food service industry; to why it offers fascinating and rewarding careers. Additionally, he writes about the influence educators have on students in this regard. “Educators can speak about how the food service industry has benefited them both personally and professionally,” says Brother Zaccarelli. “We get excited about alerting students to the many opportunities and, in fact, serve as “salespersons” for the industry to whoever (school administrators, legislators, and peers in the educational institution) will listen.” Brother Zaccarelli also speaks to growth and changes in food service, and even more importantly about the people and faces behind everything that food service, and hospitality in general comprise. The author will have you know, that people are what drive an educator. “What makes the food service industry so great? At the heart of this question's answer is people: the people whom it serves in institutional and commercial operations of all types; the people who work within it; the people who provide the goods, services, and equipment to it; the people who study it,” says Brother Zaccarelli. “All of these groups have, of course, a vested personal and/or professional interest in seeing our industry improve.” Another concept the author would like you to absorb, and it’s even more so true today than yesterday, is the prevalence of convergence and divergence within food service. For food service and beyond, it is the common denominators and differences that make the hospitality-food service industry so dynamic and vibrant. These are the winds of change presented to an educator who wants to have a positive impact on students. The author warns that the many elements involved in the food service industry conspire to erode quality of service in an industry that is also persistently expanding, and whose cornerstone principles are underpinned by service itself. “The three concerns addressed - quality, employees, and marketing - are intimately related,” Brother Zaccarelli says in stripping-down the industry to bare essentials. He defines and addresses the issues related to each with an eye toward how education can reconcile said issues.

O corpo em Michel Onfray

This inquiry looks it to think of the body through Hedonistic Philosophy of Michel Onfray. To compose his written, the philosopher launches strong criticism to the asceticism (constituted by the philosophical tradition and by the monoteístas religions), accusing it of despise the body and the pleasure of his teachings, anchored by the Christian moral. However, his philosophy defends the hedonismo and emphasizes the pleasure as an ethical / moral beginning, which aims the other as much as the individual himself, elevating the body and his potentialities through five senses. The contemplated philosophy allowed us think on the Physical Education, area wich, traditionally, was tied to the execution of disciplinary tasks of the body, disregarding the sensibility of his pedagogic practice. In this scenery, there is an ideal of body that attacks us daily, intensified by this area, which turns in the ethical problem of the body. From then, we launch our questions: From Michel Onfray philosophy, how the body shapes between the asceticism and the hedonismo?, What are the possible implications for the Physical Education? Ruled in the method of the Hedonistic Materialism, proposed by Michel Onfray, we think about this inquiry on two central points that contemplate our categories of study to be known: Glorious body and Loose living Body. We resort to Michel Onfray´s books, as well as, interviews given by the author in magazines / newspapers to help in our inquiry intentions. For the approach ethics / esthetics in the Physical Education, we use the texts of Silvino Santin and Hugo Lovisolo. Besides, we brought the cinema dialog. We classify this inquiry as a true Odyssey that transported us to unknown places and as a return to other already visited. This travel provided teachings that will help our wisdom on how survive the life, alerting us for the worship to the body like the cultivation of ourselves, and not as search of reaching physical standards stipulated by the society in force.

Early warning systems for cyber defence

Cybercriminals ramp up their efforts with sophisticated techniques while defenders gradually update their typical security measures. Attackers often have a long-term interest in their targets. Due to a number of factors such as scale, architecture and nonproductive traffic however it makes difficult to detect them using typical intrusion detection techniques. Cyber early warning systems (CEWS) aim at alerting such attempts in their nascent stages using preliminary indicators. Design and implementation of such systems involves numerous research challenges such as generic set of indicators, intelligence gathering, uncertainty reasoning and information fusion. This paper discusses such challenges and presents the reader with compelling motivation. A carefully deployed empirical analysis using a real world attack scenario and a real network traffic capture is also presented.

Entre o cartão-postal e a cidade real: um estudo sobre paisagem e produção imobiliária em Natal/RN

Recent studies concerning the landscape have investigated the most important activities that contribute for its modification and have tried to better understand the society through the marks left by its quotidian. It is understood that singular landscapes constitute the cultural patrimonies of the cities, once they are part of the daily life of the citizens and are present in their social representations. Some contemporary authors defend the preservation of the natural and urban landscape trying, specially, to keep its importance for the local population. Natal is a city where the ambient qualities are well defined and known by the beauty of the area where it is located. Situated just between a river and the sea, the city grew following its geographic characteristics. The Potengi River, the Atlantic Ocean and the vast dunes ecosystem represented natural limits to the urban expansion; at the same time they have favored the development of a landscape pattern marked by the dialectic between the natural elements and the human interventions. However, this relationship changed after the intensification of the high rising development process that took place since the 1960s. The urban legislation tried to preserve the features of the local landscape delimiting Areas for Controlling Building High , destined to protect the scenic value of some parts of the city. On the other hand, the civil construction sector has made constant pressure in sense to abolish or to modify this legal instrument, aiming profits that have increased, in the 1990s, because of the consumption and the qualification of the urban space for tourist activities. It is necessary the raising of new elements to stimulate the quarrel about the landscape preservation, the process of the urban space production and the best way for the legislation implementation. This work tries to raise elements about the subject at local level, in sense to use Natal City experience to contribute for the formulation of indicators to raise the question about the lack of measure for subjective values, for example the cultural and affective value of the landscape. The natural elements inserted in the urban profile, represent strong visual references and supply identity to the town; they are part of the collective imaginary and are detached in the social context of the city. Then, why the preservation of the landscape, that estimates the improvement in the quality of life, is not enough to justify the controlling building high already previewed as part of Natal City Legislation? These questions send us to the approach of the landscape, as a community patrimony, alerting that some of its significant esthetics attributes must be preserved as a legacy for the future generations

Utilising presence in places to support mobile interaction

Physical places are given contextual meaning by the objects and people that make up the space. Presence in physical places can be utilised to support mobile interaction by making access to media and notifications on a smartphone easier and more visible to other people. Smartphone interfaces can be extended into the physical world in a meaningful way by anchoring digital content to artefacts, and interactions situated around physical artefacts can provide contextual meaning to private manipulations with a mobile device. Additionally, places themselves are designed to support a set of tasks, and the logical structure of places can be used to organise content on the smartphone. Menus that adapt the functionality of a smartphone can support the user by presenting the tools most likely to be needed just-in-time, so that information needs can be satisfied quickly and with little cognitive effort. Furthermore, places are often shared with people whom the user knows, and the smartphone can facilitate social situations by providing access to content that stimulates conversation. However, the smartphone can disrupt a collaborative environment, by alerting the user with unimportant notifications, or sucking the user in to the digital world with attractive content that is only shown on a private screen. Sharing smartphone content on a situated display creates an inclusive and unobtrusive user experience, and can increase focus on a primary task by allowing content to be read at a glance. Mobile interaction situated around artefacts of personal places is investigated as a way to support users to access content from their smartphone while managing their physical presence. A menu that adapts to personal places is evaluated to reduce the time and effort of app navigation, and coordinating smartphone content on a situated display is found to support social engagement and the negotiation of notifications. Improving the sensing of smartphone users in places is a challenge that is out-with the scope of this thesis. Instead, interaction designers and developers should be provided with low-cost positioning tools that utilise presence in places, and enable quantitative and qualitative data to be collected in user evaluations. Two lightweight positioning tools are developed with the low-cost sensors that are currently available: The Microsoft Kinect depth sensor allows movements of a smartphone user to be tracked in a limited area of a place, and Bluetooth beacons enable the larger context of a place to be detected. Positioning experiments with each sensor are performed to highlight the capabilities and limitations of current sensing techniques for designing interactions with a smartphone. Both tools enable prototypes to be built with a rapid prototyping approach, and mobile interactions can be tested with more advanced sensing techniques as they become available. Sensing technologies are becoming pervasive, and it will soon be possible to perform reliable place detection in-the-wild. Novel interactions that utilise presence in places can support smartphone users by making access to useful functionality easy and more visible to the people who matter most in everyday life.