Why Not to Use Kidney Grafts From Elderly Donors

Background. Kidney transplantation is widely recognized as the best treatment in patients who require renal replacement therapy. Although considered a clinical and surgical triumph, it is also a source of frustration because of lack of donor organs and the growth of waiting lists. Strategies need to be developed to increase the supply of organs. One measure is use of expanded criteria for donation. Objective. To evaluate the effect of donor age on cadaver graft survival. Materials and Methods. We reviewed the medical records for 454 patients who underwent kidney transplantation with cadaver donors from April 1987 to December 2003. Results. Donor age had a significant effect on kidney transplant survival. Survival of grafts from donors aged 16 to 40 years (mean, 143.30 months) was significantly greater compared with that of grafts from donors older than 40 years (66.46 months) (P = .005). The HLA matching and cold ischemia time did not significantly affect transplant survival (P = .98 and P = .16, respectively). Conclusions. Kidneys from cadaver donors older than 40 years significantly compromised graft survival, generating a negative effect via early return of recipients to waiting lists and increasing the rate of repeat transplantation, risk of death, and unnecessary costs.

A Context Noise Model of Episodic Recognition Memory

Item noise models of recognition assert that interference at retrieval is generated by the words from the study list. Context noise models of recognition assert that interference at retrieval is generated by the contexts in which the test word has appeared. The authors introduce the bind cue decide model of episodic memory, a Bayesian context noise model, and demonstrate how it can account for data from the item noise and dual-processing approaches to recognition memory. From the item noise perspective, list strength and list length effects, the mirror effect for word frequency and concreteness, and the effects of the similarity of other words in a list are considered. From the dual-processing perspective, process dissociation data on the effects of length. temporal separation of lists, strength, and diagnosticity of context are examined. The authors conclude that the context noise approach to recognition is a viable alternative to existing approaches. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Teledermatology: a review

Teledermatology holds great potential for revolutionizing the delivery of dermatology services, providing equitable service to remote areas and allowing primary care physicians to refer patients to dermatology centres of excellence at a distance. However, before its routine application asa service tool, its reliability, accuracy and cost-effectiveness need to be verified by rigorous evaluation. Teledermatology can be applied in one of two ways: it may be conducted in real-time, utilizing videoconferencing equipment, or by store-and-forward methods, when transmitted digital images or photographs are submitted with a clinical history. While there is a considerable range of reported accuracy and reliability, evidence suggests that teledermatology will become increasingly utilized and incorporated into more conventional dermatology service delivery systems. Studies to date have generally found that real-time dermatology is likely to allow greater clinical information to be obtained from the patient. This may result in fewer patients requiring conventional consultations, but it is generally more time-consuming and costly to the health service provider It is often favoured by the patient because of the instantaneous nature of the diagnosis and management regimen for the condition, and it has educational value to the primary care physician. Store-and-forward systems of teledermatology often give high levels of diagnostic accuracy, and are cheaper and more convenient for the health care provider, but lack the immediacy of patient contact with the dermatologist, and involve a delay in obtaining the diagnosis and advice on management. It is increasingly likely that teledermatology will prove to be a significant tool in the provision of dermatology services in the future. These services will probably be provided by store-and-forward digital image systems, with real-time videoconferencing being used for case conferences and education. However, much more research is needed into the outcomes and Limitations of such a service and its effect on waiting lists, as well as possible cost benefits for patients, primary health care professionals and dermatology departments.

Abordagens metodológicas para avaliar risco de extinção de espécies de Brachyteles (Primates : Atelidae)

A distribuição geográfica de um táxon é limitada por aspectos ecológicos e históricos. Muitas atividades humanas têm causado modificações na cobertura vegetal, o que leva à fragmentação e perda do habitat. Isso tem levado à extinção local de populações de várias espécies, alterando sua distribuição geográfica. Entre elas estão as duas espécies do gênero Brachyteles (os muriquis), que são primatas endêmicos de um dos biomas mais afetados por esses processos, a Mata Atlântica. A União Internacional para a Conservação da Natureza (UICN) é uma organização que busca conservar a biodiversidade. Entre outros critérios, utiliza o conhecimento sobre as distribuições geográficas restritas das espécies para classificá-las em categorias de ameaça de extinção, nas chamadas listas vermelhas. Para isso, utiliza parâmetros espaciais, cujos resultados indicam o risco de extinção de determinado táxon em relação à sua distribuição geográfica. Muitas vezes os cálculos desses parâmetros são realizados de maneira subjetiva, de maneira que é importante a busca de métodos que tornem as classificações mais objetivas, precisas e replicáveis. Nesse contexto, o presente trabalho testou diferentes métodos de cálculos de três parâmetros relacionados à distribuição geográfica de B. hypoxanthus e B. arachnoides. Tratam-se de espécies ameaçadas de extinção, com localidades de ocorrência bem conhecidas, que foram profundamente afetadas pela degradação da Mata Atlântica. Assim, podem ser consideradas bons modelos para essas análises. Foi construído um banco de dados de localidades de ocorrência atuais das duas espécies. Por meio de abordagens de Sistemas de Informação Geográfica (SIG), foram estimadas a Extensão de Ocorrência (EOO) através de Mínimo Polígono Convexo e α-hull e Área de Ocupação (AOO) e Subpopulações por meio de métodos de grids, buffers circulares e α-hull, em diferentes escalas espaciais. Os resultados dos cálculos desses parâmetros foram comparados para identificar as abordagens e escalas mais adequadas para a avaliação de risco de extinção. Esses resultados indicam que as listas de localidades e os mapas de distribuição disponibilizados pela UICN precisam ser atualizados. Além disso, sugerem que α-hull é uma abordagem vantajosa para EOO e o método de buffers é mais adequado para os parâmetros de AOO e Subpopulações, quando utiliza escalas espaciais menores. Também foi utilizada a ferramenta GeoCAT, para as duas espécies. Essa ferramenta, por realizar análises de EOO e AOO instantâneas e por seus resultados serem semelhantes aos de outras análises, serve como uma abordagem preliminar de risco de extinção baseado no critério de distribuição geográfica.

O planejamento econômico no Brasil: considerações críticas

In the past thirty years, a series of plans have been developed by successive Brazilian governments in a continuing effort to maximize the nation's resources for economic and social growth. This planning history has been quantitatively rich but qualitatively poor. The disjunction has stimulated Professor Mello e Souza to address himself to the problem of national planning and to offer some criticisms of Brazilian planning experience. Though political instability has obviously been a factor promoting discontinuity, his criticisms are aimed at the attitudes and strategic concepts which have sought to link planning to national goals and administration. He criticizes the fascination with techniques and plans to the exclusion of proper diagnosis of the socio-political reality, developing instruments to coordinate and carry out objectives, and creating an administrative structure centralized enough to make national decisions and decentralized enough to perform on the basis of those decisions. Thus, fixed, quantified objectives abound while the problem of functioning mechanisms for the coordinated, rational use of resources has been left unattended. Although his interest and criticism are focused on the process and experience of national planning, he recognized variation in the level and results of Brazilian planning. National plans have failed due to faulty conception of the function of planning. Sectorial plans, save in the sector of the petroleum industry under government responsibility, ha e not succeeded in overcoming the problems of formulation and execution thereby repeating old technical errors. Planning for the private sector has a somewhat brighter history due to the use of Grupos Executivos which has enabled the planning process to transcend the formalism and tradition-bound attitudes of the regular bureaucracy. Regional planning offers two relatively successful experiences, Sudene and the strategy of the regionally oriented autarchy. Thus, planning history in Brazil is not entirely black but a certain shade of grey. The major part of the article, however, is devoted to a descriptive analysis of the national planning experience. The plans included in this analysis are: The Works and Equipment Plan (POE); The Health, Food, Transportation and Energy Plan (Salte); The Program of Goals; The Trienal Plan of Economic and Social Development; and the Plan of Governmental Economic Action (Paeg). Using these five plans for his historical experience the author sets out a series of errors of formulation and execution by which he analyzes that experience. With respect to formulation, he speaks of a lack of elaboration of programs and projects, of coordination among diverse goals, and of provision of qualified staff and techniques. He mentions the absence of the definition of resources necessary to the financing of the plan and the inadequate quantification of sectorial and national goals due to the lack of reliable statistical information. Finally, he notes the failure to coordinate the annual budget with the multi-year plans. He sees the problems of execution as beginning in the absence of coordination between the various sectors of the public administration, the failure to develop an operative system of decentralization, the absence of any system of financial and fiscal control over execution, the difficulties imposed by the system of public accounting, and the absence of an adequate program of allocation for the liberation of resources. He ends by pointing to the failure to develop and use an integrated system of political economic tools in a mode compatible with the objective of the plans. The body of the article analyzes national planning experience in Brazil using these lists of errors as rough model of criticism. Several conclusions emerge from this analysis with regard to planning in Brazil and in developing countries, in general. Plans have generally been of little avail in Brazil because of the lack of a continuous, bureaucratized (in the Weberian sense) planning organization set in an instrumentally suitable administrative structure and based on thorough diagnoses of socio-economic conditions and problems. Plans have become the justification for planning. Planning has come to be conceived as a rational method of orienting the process of decisions through the establishment of a precise and quantified relation between means and ends. But this conception has led to a planning history rimmed with frustration, and failure, because of its rigidity in the face of flexible and changing reality. Rather, he suggests a conception of planning which understands it "as a rational process of formulating decisions about the policy, economy, and society whose only demand is that of managing the instrumentarium in a harmonious and integrated form in order to reach explicit, but not quantified ends". He calls this "planning without plans": the establishment of broad-scale tendencies through diagnosis whose implementation is carried out through an adjustable, coherent instrumentarium of political-economic tools. Administration according to a plan of multiple, integrated goals is a sound procedure if the nation's administrative machinery contains the technical development needed to control the multiple variables linked to any situation of socio-economic change. Brazil does not possess this level of refinement and any strategy of planning relevant to its problems must recognize this. The reforms which have been attempted fail to make this recognition as is true of the conception of planning informing the Brazilian experience. Therefore, unworkable plans, ill-diagnosed with little or no supportive instrumentarium or flexibility have been Brazil's legacy. This legacy seems likely to continue until the conception of planning comes to live in the reality of Brazil.

A questão da verdade e o desenvolvimento de memórias falsas provenientes de processos associativos

RESUMO: O objectivo desta investigação foi analisar as diferenças relativas à produção de recordações falsas, de acordo com o paradigma de associados convergentes. Foram realizadas experiências, nas quais participaram crianças entre os 4 e os 5 anos e adultos. Como metodologia adoptámos a apresentação de dez listas de palavras associadas a uma palavra não incluída na lista (palavra crítica). A ordem das palavras de cada lista foi manipulada de forma a ser apresentada em sentido decrescente de força associativa (ordem standard) ou em sentido crescente (ordem invertida). A instrução fornecida antes da apresentação das listas foi também manipulada nas crianças de forma a incluir uma condição em que se pedia para as crianças repetirem os primeiros três itens de cada lista com o intuito de aumentar a recordação desses itens (instrução de primazia). A predição inicial foi de que este tipo de manipulação ao aumentar a recordação dos itens mais fortemente associados ao item crítico poderia também levar a um aumento das recordações falsas relativas ao item crítico. Os resultados mostraram que a instrução de primazia não teve efeito na produção de memórias falsas e que, nas crianças o uso de listas invertidas diminuiu o número evocações falsas, não tendo qualquer efeito nos adultos. Não foram encontradas diferenças estatisticamente significativas entre as crianças e os adultos relativamente à produção de memórias falsas. ABSTRACT: The purpose of this investigation was to analyze the differences in the production of false memories, according to the paradigm of converging associates. Experiments were carried out, which involved children between 4 and 5 and adults. The methodology adopted was the presentation of ten lists of words associated with a word not included in the list (critical word). The word order of each list was manipulated so as to be presented in descending order of associative strength (standard order) or an increasing trend (inverted order). The instruction given prior to the presentation of lists was also manipulated, in children, to include a condition in which it was asked children to repeat the first three items in each list in order to increase the recall of these items (primacy' instruction). The initial prediction was that this kind of manipulation witch increase the recall of the items most strongly associated with the critical item could also lead to an increase in false memories relative to the critical item. The results showed that the primacy instruction had no effect on production of false memories and that, in children the use of inverted lists reduced the number of false evocations and has no effect in adults. There were no statistically significant differences between children and adults for the production of false memories.

Geographical stratification by socio-economic status: methodology from a household survey with elderly people in S. Paulo, Brazil

Considering that in most developing countries there are still no comprehensive lists of addresses for a given geographical area, there has always been a problem in drawing samples from the community, ensuring randomisation in the selection of the subjects. This article discusses the geographical stratification by socio-economic status used to draw a multistage random sample from a community-based elderly population living in a city like S. Paulo - Brazil. Particular attention is given to the fact that the proportion of elderly people in the total population of a certain area appeared to be a good discriminatory variable for such stratification. The validity of the stratification method is analysed in the light of the socio-economic results obtained in the survey.

On the moroccan tsunami catalogue

A primary tool for regional tsunami hazard assessment is a reliable historical and instrumental catalogue of events. Morocco by its geographical situation, with two marine sides, stretching along the Atlantic coast to the west and along the Mediterranean coast to the north, is the country of Western Africa most exposed to the risk of tsunamis. Previous information on tsunami events affecting Morocco are included in the Iberian and/or the Mediterranean lists of tsunami events, as it is the case of the European GITEC Tsunami Catalogue, but there is a need to organize this information in a dataset and to assess the likelihood of claimed historical tsunamis in Morocco. Due to the fact that Moroccan sources are scarce, this compilation rely on historical documentation from neighbouring countries (Portugal and Spain) and so the compatibility between the new tsunami catalogue presented here and those that correspond to the same source areas is also discussed.

e-learning in the classroom?

As teachers, we are challenged everyday to solve pedagogical problems and we have to fight for our students’ attention in a media rich world. I will talk about how we use ICT in Initial Teacher Training and give you some insight on what we are doing. The most important benefit of using ICT in education is that it makes us reflect on our practice. There is no doubt that our classrooms need to be updated, but we need to be critical about every peace of hardware, software or service that we bring into them. It is not only because our budgets are short, but also because e‐learning is primarily about learning, not technology. Therefore, we need to have the knowledge and skills required to act in different situations, and choose the best tool for the job. Not all subjects are suitable for e‐learning, nor do all students have the skills to organize themselves their own study times. Also not all teachers want to spend time programming or learning about instructional design and metadata. The promised land of easy use of authoring tools (e.g. eXe and Reload) that will lead to all teachers become Learning Objects authors and share these LO in Repositories, all this failed, like previously HyperCard, Toolbook and others. We need to know a little bit of many different technologies so we can mobilize this knowledge when a situation requires it: integrate e‐learning technologies in the classroom, not a flipped classroom, just simple tools. Lecture capture, mobile phones and smartphones, pocket size camcorders, VoIP, VLE, live video broadcast, screen sharing, free services for collaborative work, save, share and sync your files. Do not feel stressed to use everything, every time. Just because we have a whiteboard does not mean we have to make it the centre of the classroom. Start from where you are, with your preferred subject and the tools you master. Them go slowly and try some new tool in a non‐formal situation and with just one or two students. And you don’t need to be alone: subscribe a mailing list and share your thoughts with other teachers in a dedicated forum, even better if both are part of a community of practice, and share resources. We did that for music teachers and it was a success, in two years arriving at 1.000 members. Just do it.

Modalidades síncronas e assíncronas no ensino da radiologia do sistema nervoso: estilos e resultados de aprendizagem

Lidar com as problemáticas da saúde, implica um domínio dos processos cognitivos (raciocínio, resolução de problemas e tomada de decisão) e de desempenhos práticos, o que obriga a afectação de um conjunto de atitudes e comportamentos específicos. Este estudo, implementou e avaliou o impacto de experiências pedagógicas desenvolvidas com os estudantes da unidade curricular Radiologia do Sistema Nervoso (RSN) da Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL). Aplicaram-se metodologias de ensino mistas (presenciais e virtuais) utilizadas na leccionação teórica e prática no ano curricular 2008/2009. Para a avaliação do perfil de aprendizagem dos estudantes foi aplicado o método de Honey & Munford e para a avaliação e monitorização dos conhecimentos aplicaram-se check list baseadas nos conteúdos programáticos. A monitorização das ferramentas da plataforma moodle complementaram a restante informação. Verificou-se uma progressão de aprendizagem positiva para um grupo de estudantes maioritariamente do estilo reflexivo (média=10,6 estudantes). As conclusões apontaram para um impacto positivo quanto à aplicação das metodologias híbridas com maior índice de sucesso para a metodologia assíncrona. Verificou-se também mais flexibilidade no acesso aos conteúdos porém com algumas limitações tais como residência inicial por parte dos estudantes, maior carga de trabalho para os docentes, falta de terminais para acesso à plataforma e pouca experiência de todos os envolvidos no domínio e manipulação da plataforma. ABSTRACT - This study focused on the role of cognitive processes (reasoning, problem solving and decision making) and performance practice in the formation of attitudes and behaviours relating to health issues. It was conducted to evaluate the effects of pedagogical experiences on students who participated in the course in radiography in the Nervous System Imaging Unit (RSN) of the Lisbon Health School of Technology. Mixed (face-to-face and virtual) teaching methodologies were used in theory and practice sessions. Honey and Munford’s method was used to evaluate the learning profile of students. To monitor and evaluate students’ knowledge acquisition, check lists based on program topics were applied. Other information was supplied through the learning platform of Moodle. The student group with mostly a reflective learning style increased their knowledge. The asynchronous method was shown to produce a higher success rate and more flexibility in accessing content but also registered some limitations such as resistance by students, increased workload for teachers, lack of access to the platform and inexperience of all involved in handling the platform.

Developing multiple - choice questions in mathematics

In this paper we wish to illustrate different perspectives used to create Multiple-Choice questions and we will show how we can improve these in the construction of math tests. As it is known, web technologies have a great influence on student’s behaviour. Based on an on-line project beginning at 2007 which has been contributing to help students on their individual work, we would like to share our experience and thoughts with colleagues who have a common concern when they have the task of constructing Multiple-Choice tests. We feel that Multiple-Choice tests play an important and a very useful supporting role in selfevaluation or self-examination of our students. Nonetheless, good Multiple–Choice Test Items are generally more complex and time-consuming to create than other types of tests. It requires a certain amount of skill. However, this skill maybe increases through study, practice and experience. This paper discusses a number of issues related to the use of Multiple-Choice questions, lists the advantages and disadvantages of this question format contrasting it with open questions. Some examples are given in this context.

O Balanced Scorecard no sector de controlo contabilístico

Mestrado em Contabilidade e Gestão das Instituições Financeiras

Plantas ornamentais tóxicas: contributo para a sua caracterização e perceção do risco de exposição ocupacional

Mestrado em Segurança e Higiene do Trabalho.

Crianças com défices no controlo motor: contributo para a elaboração do core set da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF)

A CIF é um sistema de classificação adotado pela OMS, que serve de referência universal para descrever, avaliar e medir saúde e incapacidade, a nível individual e ao nível da população. Contudo, apesar do interesse internacional gerado em torno da CIF, esta é considerada uma classificação complexa e extensa, fato que despoletou a criação de core sets – listas de itens da CIF especificamente selecionados pela sua relevância na descrição e qualificação de uma determinada condição de saúde – como resposta a esta problemática. Até à data, foram desenvolvidos core sets para várias patologias comuns. Contudo, apesar do controlo motor ser uma área de investigação muito reconhecida nos últimos 20 anos, ainda não possui um core set próprio. Assim, o objetivo deste estudo é contribuir para o desenvolvimento de um core set, com base na CIF-CJ, dirigido para uma descrição abrangente das competências inerentes a crianças, dos 6 aos 18 anos de idade, com défices no controlo motor. Deste modo, recorreu-se a uma revisão da literatura sobre a temática em estudo, de modo a reunir informação para a construção de uma proposta a core set, posteriormente sujeita ao escrutínio de peritos, através do recurso ao método de Delphi. Após várias rondas, foi alcançado um consenso acerca da lista final de códigos CIF que constituem o core set final.

Preliminary observations on the benthic marine algae of the Gorringe seabank (northeast Atlantic Ocean)

Copyright © Springer-Verlag Berlin Heidelberg and AWI 2014.