Development and evaluation of a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence

Abstract Aims: To develop and evaluate a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence. Methods: A retrospective audit of attendances at a diabetes outpatient clinic at a public, teaching hospital over a 16-month period was conducted. Logistic regression was undertaken to examine risk factors associated with medication problems relating to hypoglycaemia and medication non-adherence and the most predictive set of factors comprise the Diabetes Medication Risk Screening Tool. Evaluating the tool involved assessing sensitivity and specificity, positive and negative predictive values, cut-off scores, inter-rater reliability, and content validity. Results: The Diabetes Medication Risk Screening Tool comprises seven predictive factors: age, living alone, English language, mental and behavioural problems, comorbidity index score, number of medications prescribed, and number of high-risk medications prescribed. The tool has 76.5% sensitivity, 59.5% specificity, and has a 65.1% positive predictive value, and a 71.8% negative predictive value. A score of 27 or more out of 62 was associated with high-risk of a medication problem. The inter-rater reliability of the tool was high (κ = 0.79, 95% CI 0.75 - 0.84) and the content validity index was 99.4%. Conclusion: The Diabetes Medication Risk Screening Tool has good psychometric properties and can proactively identify people with diabetes at greatest risk of medication problems relating to hypoglycaemia and medication non-adherence.

Alternative service delivery models for families with a new speech generating device: perspectives of parents and therapists

Purpose: Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

Method: Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants’ suggestions for the optimal implementation of these approaches.

Result: Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

Conclusion: Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.

It’s not all about language ability: motivational cultural intelligence matters in call center performance

his study focuses on the role of motivational cultural intelligence (CQ) in call center performance. Call centers mainly rely on verbal communication with language ability playing a significant role in delivery of tasks. This study argues that motivational CQ, or the interest and efficacy when interacting with individuals from culturally diverse backgrounds, plays a significant role in call center performance. This study was conducted in the Philippines, one of the top destinations for offshore services like call centers. Studies were conducted at two time points to determine the relationship between language ability, motivational CQ, and task performance. At Time 1, the language ability of 125 call center agent applicants was determined and assessed. At Time 2 which was conducted six months later, performance data were obtained and the level of the motivational CQ of the respondents measured. Results show that language ability is positively and significantly related to task performance. However, when motivational CQ was included, the relationship between language ability and task performance became non-significant, which conveys the full mediating role of motivational CQ in that relationship.

Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies

Background

Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.

Method

We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.

Findings

There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.

Conclusion

Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.

Signs and codes in early childhood: An investigation of young children’s creative approaches to communication

PEOPLE COMMUNICATE AND MAKE meaning through the use of the signs, codes and rules of their community and its language/s. On the way to learning these signs, codes and rules, children often create or invent their own unique and sometimes temporary systems of meaning making. In this paper we use Vygotsky’s concept of semiotic mediation and Bernstein’s code theory to reflect on some examples of children’s creative approaches to communication that involved the creation and use of signs. We will argue that young language learners’ invention of their own languages and creative use of drawing as a form of sign creation are symbolic expressions of their intent to generate and reinforce desired social and cultural situations of learning. We conclude that individuals mediate social and individual functioning in order to make meaning of their world, and argue for a move away from viewing second language learning and emergent writing as static sets of abilities to a more dynamic interpretation.

DCM Boost interleaved converter for operation in AC and DC to trolleybus application

This paper is based on the development and experimental analysis of a DCM Boost interleaved converter suitable for application in traction systems of electrical vehicles pulled by electrical motors (Trolleybus), which are powered by urban DC or AC distribution networks. This front-end structure is capable of providing significant improvements in trolleybuses systems and in the urban distribution network costs, and efficiency. The architecture of proposed converter is composed by five boost power cells in interleaving connection, operating in discontinuous conduction mode. Furthermore, the converter can operate as AC-DC converter, or as DC-DC converter providing the proper DC output voltage range required by DC or AC adjustable speed drivers. Therefore, when supplied by single-phase AC distribution networks, and operating as AC-DC converter, it is capable to provide high power factor, reduced harmonic distortion in the input current, complying with the restrictions imposed by the IEC 61000-3-4 standards. The digital controller has been implemented using a low cost FPGA and developed totally using a hardware description language VHDL and fixed point arithmetic. Thus, two control strategies are evaluated considering the compliance with input current restrictions imposed by IEC 61000-3-4 standards, the regular PWM modulation and a current correction PWM modulation. In order to verify the feasibility and performance of the proposed system, experimental results from a 15 kW low power scale prototype are presented, operating in DC and AC conditions.

Avaliação e intervenção da disortografia baseada na semiologia dos erros: revisão da literatura

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

Aprendizagem da língua japonesa apoiada por ferramentas computacionais: estudo e desenvolvimento do jogo Karuchā Ships Invaders

The use of technology tools for teaching and learning has grown increasingly in our daily life. In this context, a branch that has had tremendous growth is the area of teaching and learning language through computational tools. The study of CALL (Computer Assisted Language Learning), accomplished in this research, aims to evaluate existing tools in this context, focused specifically on the Japanese language; and from this study, accomplish the development of a new computational tool that can assist teaching/learning of the Japanese language. As results, we present a wide survey on the subject in various technologies/devices, as well as the complete development process of a new tool, the Karuchā Ships Invaders game, that proposes to teach basic concepts of the language, blended with entertainment, and still, focusing on the Brazilian students of Japanese language audience. We will present all the concept phases of the game and its evolution through the research, as well as an interface evaluation. Still, we present proposal and validation of a method to evaluate motivational aspects of computational tools with educational focus, and results extracted from an experiment accomplished with prospective users

Evaluation of partially dentate patients' knowledge about caries and periodontal disease

Objective: This investigation evaluated the knowledge of dental caries and periodontal disease among removable partial denture (RPD) wearers.Method: A total of 127 partially dentate patients participated in this observational study. A structured questionnaire, which included eight questions referring to knowledge about aetiology and prevention of dental caries and periodontal disease, was developed in the local language (Portuguese) and used to collect the data of all the partial denture wearers. A descriptive analysis of data was performed by means of drafting tables.Results: The results demonstrated that 68.5% of patients interviewed had previously received information about oral health care. With regard to bacterial plaque, it was observed that only 34.6% reported having knowledge of this. Whereas, in relation to caries, 76.4% of the interviewees replied that they knew the meaning of this. Nevertheless, 28.3% referred to caries as a whole in the teeth, 16.5% as bad teeth and 9.4% bacteria/creatures on the teeth. Only 17.3% of the partially edentulous patients evaluated were shown to know what disease of the gingiva was.Conclusion: By means of the methodology applied, it could be concluded that the patients who wore RPDs presented deficient knowledge with regard to the prevention, aetiology and development of dental caries and periodontal disease.

WORD-FINDING DIFFICULTIES, VERBAL PARAPHASIAS, AND VERBAL DYSPRAXIA IN 10 INDIVIDUALS WITH FRAGILE-X-SYNDROME

Speech/language disorders are common in the fragile X syndrome. [Howard-Peebles, 1979: Am J Hom Genet 31:214-222; Renier et al., 1983: J Ment Defic Res 27:51-59; Sparks, 1984: Birth Defects and Speech-Language Disorders, pp, 39-43; Hanson et al., 1986: Am J Med Genet 23:195-206]. Verbal paraphasias have been considered a rare feature and word-finding difficulties have seldom been reported. Here we report on ten Brazilian patients who were evaluated for speech/language disturbances and found that word-finding difficulties were present in 50% of the cases, which is a slightly higher frequency than that of clear dyspraxia. We suggest, therefore, that word-finding difficulties and verbal dyspraxia can be a common feature within the spectrum of this syndrome. Additional speech findings are discussed. (C) 1995 Wiley-Liss, Inc.

Relational learning in children with deafness and cochlear implants

This four-experiment series sought to evaluate the potential of children with neurosensory deafness and cochlear implants to exhibit auditory-visual and visual-visual stimulus equivalence relations within a matching-to-sample format. Twelve children who became deaf prior to acquiring language (prelingual) and four who became deaf afterwards (postlingual) were studied. All children learned auditory-visual conditional discriminations and nearly all showed emergent equivalence relations. Naming tests, conducted with a subset of the: children, showed no consistent relationship to the equivalence-test outcomes.. This study makes several contributions: to the literature on stimulus equivalence. First; it demonstrates that both pre- and postlingually deaf children-can: acquire auditory-visual equivalence-relations after cochlear implantation, thus demonstrating symbolic functioning. Second, it directs attention to a population that may be especially interesting for researchers seeking to analyze the relationship. between speaker and listener repertoires. Third, it demonstrates the feasibility of conducting experimental studies of stimulus control processes within the limitations of a hospital, which these children must visit routinely for the maintenance of their cochlear implants.

Characterization of language disorders in children with lead poisoning

Background: lead poisoning can have a negative impact on the neuropsychological functions, including language, due to the damage it causes to the developthent of the Central Nervous System. Aim: to verify the occurrence of language disorders in children who suffered from led poisoning and to verify the correlation between the lead concentration level in the blood and the language disorders presented by the children. Method: language evaluation of 20 preschoolers, with lead concentration level in the blood above 10μg/dl. Results: 13 children presented language impairment involving only phonology or more than one language subsystem. The statistical analysis indicated that no correlation exists between the severity of the language impairment and the concentration levels of lead. Conclusion: the number of children with language impairment indicates lead poisoning as a risk factor for the present alterations, even though other risk factors for language disorders were found and the absence of correlation between the investigated variables.

E-business innovation and customs renovation for secure supply chain management

Includes bibliography

Eficácia do programa de remediação fonológica play on em escolares com dislexia de desenvolvimento

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação do efeito de um programa de ensino de leitura e escrita sobre a fala de crianças usuárias de implante coclear

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