Improvement of adynamic bone disease after renal transplantation

Low bone remodeling and relatively low serum parathyroid hormone (PTH) levels characterize adynamic bone disease (ABD). The impact of renal transplantation (RT) on the course of ABD is unknown. We studied prospectively 13 patients with biopsy-proven ABD after RT. Bone histomorphometry and bone mineral density (BMD) measurements were performed in the 1st and 12th months after RT. Serum PTH, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and osteocalcin were measured regularly throughout the study. Serum PTH levels were slightly elevated at transplantation, normalized at the end of the third month and remained stable thereafter. Bone biopsies performed in the first month after RT revealed low bone turnover in all patients, with positive bone aluminum staining in 5. In the 12th month, second biopsies were performed on 12 patients. Bone histomorphometric dynamic parameters improved in 9 and were completely normalized in 6, whereas no bone mineralization was detected in 3 of these 12 patients. At 12 months post-RT, no bone aluminum was detected in any patient. We also found a decrease in lumbar BMD and an increase in femoral BMD. Patients suffering from ABD, even those with a reduction in PTH levels, may present partial or complete recovery of bone turnover after successful renal transplantation. However, it is not possible to positively identify the mechanisms responsible for the improvement. Identifying these mechanisms should lead to a better understanding of the physiopathology of ABD and to the development of more effective treatments.

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 ± 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 ± 16 and 36 ± 12%, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40%) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 ± 14 vs 14 ± 5 cmH2O, and 87 ± 30 vs 34 ± 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 ± 0.7 vs 2.3 ± 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

Financial support of graduate programs in Brazil: quo vadis?

Graduate programs provide the highest level of formal education and thus are crucial for the development of any country. However, official Brazilian data clearly show a dramatic decrease in the number and values of scholarships available to graduate programs in Brazil over the last few years, despite the importance and growth of such programs. Between 1995 and 2004, investment by the Coordenadoria de Aperfeiçoamento de Pessoal do Ensino Superior (CAPES, subordinate to the Ministry of Education and Culture) in funding scholarships, corrected for inflation in the period, actually decreased by 51%. In addition, during the period between 1994 and 2004, there was a loss of about 60% in the purchasing power of the graduate scholarships provided by CAPES and the National Council for Science and Technology (CNPq). To reverse this trend, we propose the development of sectorial funding for Brazilian graduate programs to guarantee the availability and continuity of financial support for this strategic activity.

Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs

Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P < 0.05). The presence of myocardial ischemia during exercise was defined as a difference ≥2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.

Reduction of blood nitric oxide levels is associated with clinical improvement of the chronic pelvic pain related to endometriosis

The objective of this prospective study was to determine the plasma levels of nitric oxide (NO) in women with chronic pelvic pain secondary to endometriosis (n=24) and abdominal myofascial pain syndrome (n=16). NO levels were measured in plasma collected before and 1 month after treatment. Pretreatment NO levels (μM) were lower in healthy volunteers (47.0±12.7) than in women with myofascial pain (64.2±5.0, P=0.01) or endometriosis (99.5±12.9, P<0.0001). After treatment, plasma NO levels were reduced only in the endometriosis group (99.5±12.9 vs 61.6±5.9, P=0.002). A correlation between reduction of pain intensity and reduction of NO level was observed in the endometriosis group [correlation = 0.67 (95%CI = 0.35 to 0.85), P<0.0001]. Reduction of NO levels was associated with an increase of pain threshold in this group [correlation = -0.53 (-0.78 to -0.14), P<0.0001]. NO levels appeared elevated in women with chronic pelvic pain diagnosed as secondary to endometriosis, and were directly associated with reduction in pain intensity and increase in pain threshold after treatment. Further studies are needed to investigate the role of NO in the pathophysiology of pain in women with endometriosis and its eventual association with central sensitization.

Evaluation of novel programs in health counseling – their effectiveness in the oral health of young children, and their acceptance by parents and professionals in public dental service.

Aim and design: To evaluate family-based health counseling for young children, and to study the significance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly fi rstborn children, while children born in 2006 formed the historical control. The fi rst of the new programs emphasized oral hygiene and use of fl uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental biofi lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, father’s advanced level of education and child’s proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present fi ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.

How Lean Six Sigma and Agile principles optimize ITIL-based processes

Imagine the potential implications of an organization whose business and IT processes are well aligned and are capable of reactively and proactively responding to the external and internal changes. The Philips IT Infrastructure and Operations department (I&O) is undergoing a series of transformation activities to help Philips business keeping up with the changes. I&O would serve a critical function in any business sectors; given that the I&O’s strategy switched from “design, build and run” to “specify, acquire and performance manage”, that function is amplified. In 2013, I&O’s biggest transforming programme I&O Futures engaged multiple interdisciplinary departments and programs on decommissioning legacy processes and restructuring new processes with respect to the Information Technology Internet Library (ITIL), helping I&O to achieve a common infrastructure and operating platform (CI&OP). The author joined I&O Futures in the early 2014 and contributed to the CI&OP release 1, during which a designed model Bing Box and its evaluations were conducted through the lens of six sigma’s structured define-measure-analyze-improve-control (DMAIC) improvement approach. This Bing Box model was intended to firstly combine business and IT principles, namely Lean IT, Agile, ITIL best practices, and Aspect-oriented programming (AOP) into a framework. Secondly, the author implemented the modularized optimization cycles according to the defined framework into Philips’ ITIL-based processes and, subsequently, to enhance business process performance as well as to increase efficiency of the optimization cycles. The unique of this thesis is that the Bing Box model not only provided comprehensive optimization approaches and principles for business process performance, but also integrated and standardized optimization modules for the optimization process itself. The research followed a design research guideline that seek to extend the boundaries of human and organizational capabilities by creating new and innovative artifacts. The Chapter 2 firstly reviewed the current research on Lean Six Sigma, Agile, AOP and ITIL, aiming at identifying the broad conceptual bases for this study. In Chapter 3, we included the process of constructing the Bing Box model. The Chapter 4 described the adoption of Bing Box model: two-implementation case validated by stakeholders through observations and interviews. Chapter 5 contained the concluding remarks, the limitation of this research work and the future research areas. Chapter 6 provided the references used in this thesis.

Comparative analysis of vitamin A and iron content in food according to different food composition tables and nutritional evaluation software programs

The objective of this study was to analyze retinol equivalent and iron content in different food composition tables and nutritional evaluation software programs. A literature search was conduct to identify tables and software available in Brazil containing information about retinol equivalent and iron content that are currently used by nutritionists. Ten tables and five software programs were selected for this study. The methodology used to present the retinol equivalent and iron content was evaluated and no pattern to obtain such content was found in the tables and software programs analyzed. Only one of the tables had enough information for the calculation of retinol equivalents; this table is recommended to all Latin America As for the iron content, three of the tables analyzed stand out and therefore should be used; two of them are based on national foods and the other is recommended for use in all Latin America countries. None of the software programs evaluated use the conversion factors suggested by IVACG to assess the vitamin A content in foods. Special attention should be given to the content of iron provided in the software programs since they use tables as international sources and fortified foods.

Sopeutumattomien oppilaiden tunne- ja itsesäätelytaitojen kehittyminen: Oppilaiden ja opettajien arvioita ja kokemuksia Aggression portaat -interventiosta

Tässä tutkimuksessa tarkastellaan sopeutumattomien erityisoppilaiden tunne- ja itsesäätelytaitojen kehittymistä Aggression portaat -interventio-ohjelman avulla kolmen vuoden tutkimusjakson aikana. Käsite sopeutumaton oppilas ei ole yksiselitteisesti määriteltävissä, mutta tässä tutkimuksessa sillä tarkoitetaan yleisopetussuunnitelman mukaan opiskelevaa oppilasta, joka käyttäytymiseen ja tunne-elämään liittyvien haasteidensa vuoksi on saanut siirron erityisopetuksen oppilaaksi ja saa enintään 10 oppilaan opetusryhmässä erityistä pedagogista tukea. Tutkimuksen yksi keskeinen tehtävä oli tutkia, onko tunne- ja itsesäätelytaitojen opettamisesta hyötyä sopeutumattomien oppilaiden tunteiden hallinnan ja käyttäytymisen itsesäätelyn kannalta. Tutkimuksen teoreettisena viitekehyksenä on Rose-Krasnorin (1997) malli yksilön sosioemotionaalisesta kompetenssista täydennettynä muiden tutkijoiden näkemyksillä. Sosioemotionaalinen kompetenssi on yläkäsite, johon kuuluvat alakäsitteinä tunne- ja itsesäätelytaidot, sosiokognitiiviset taidot ja sosiaaliset taidot. Lisäksi sosioemotionaaliseen kompetenssiin vaikuttavat kiintymyssuhteet ja osallisuus sekä tavoitteet vuorovaikutuksessa ja konteksti. Tässä tutkimuksessa keskitytään tunne- ja itsesäätelytaitoihin. Interventioryhmän (N=36) muodostivat Varsinais-Suomen alueella opiskelevat sopeutumattomien oppilaiden erityiskoulun 8-13-vuotiaat oppilaat, joille opetettiin tunne- ja itsesäätelytaitoja Aggression portaat -opetusmateriaaliin (Cacciatore 2007) pohjautuvan intervention avulla. Kontrolliryhmän (N=26) oppilaat olivat interventioryhmän oppilaiden ikäisiä ja he opiskelivat Varsinais-Suomen alueen kouluissa pienluokissa myös käyttäytymiseen ja tunne-elämään liittyvien haasteidensa vuoksi. Kontrolliryhmän oppilaat eivät saaneet tutkimusjakson aikana interventio-ohjelman mukaista opetusta. Interventioryhmän oppilaat kävivät erityiskoulua, jossa kaikilla oppilailla oli sopeutumisongelmia ja kontrolliryhmän oppilaat opiskelivat yleisopetuksen koulujen yhteydessä olevilla sopeutumattomien oppilaiden pienluokilla. Tutkimusaineisto on kerätty vuosina 2010-2012. Tutkimusmetodeina olivat sekä oppilaille että opettajille laaditut Webropol-alustaiset kyselyt ja oppilaiden kirjoittamat väkivalta-aiheiset tekstit. Tutkimus- ja kontrolliryhmän oppilaille pidettiin ”Tunteiden hallinta ja käyttäytyminen”- kyselyn avulla alkumittaus syksyllä 2009 ja mittaus toistettiin keväällä 2010, 2011 ja 2012. Kyselyiden avulla selvitettiin, miten oppilaiden tunteiden kokeminen ja ilmaiseminen sekä tunteiden hallinta ja käyttäytymisen itsesäätely muuttuivat tutkimusjakson aikana. Kyselyssä kartoitettiin myös oppilaiden kokemuksia kiusaamisena ilmenevästä väkivallasta. Aineistolähtöisen sisällönanalyysin avulla selvitettiin oppilaiden kirjoitelmista heidän ajatuksiaan ja näkemyksiään väkivallasta ja ehdotuksia keinoista väkivallan vähentämiseksi. Keväällä 2012 interventioryhmän oppilaille ja opettajille laadittujen erillisten kyselyiden avulla selvitettiin sekä oppilaiden että opettajien arvioita ja kokemuksia oppilaiden tunne- ja itsesäätelytaitojen muutoksesta interventio-ohjelman avulla. Lisäksi oppilaat ja opettajat arvioivat pidettyjen tunnetaitotuntien hyödyllisyyttä oppilaille. Interventioryhmän opettajat arvioivat myös Aggression portaat -interventiomateriaalin käyttökelpoisuutta. Vuoden 2014 Perusopetuksen opetussuunnitelman perusteissa esitetyt velvoitteet opettaa kouluissa oppilaille tunne- ja vuorovaikutustaitoja edellyttävät tietoa konkreettisista käytänteistä ja tutkimusperustaisista interventio-ohjelmista. Tämän tutkimuksen tulokset osoittavat, että interventioryhmän muodostaneet sopeutumattomat oppilaat hyötyivät Aggression portaat -interventiosta. Heidän tunne- ja itsesäätelytaidoissaan tapahtui myönteistä kehitystä etenkin myönteisten tunnekokemusten lisääntymisen ja toisiin kohdistuneen fyysisen väkivallan vähenemisen osalta. Myös suhtautuminen väkivaltapelien ikärajoihin oli merkittävästi myönteisempää kuin kontrolliryhmän oppilailla, joilla kielteinen asenne lisääntyi selvästi tutkimusjakson aikana. Lisäksi interventioryhmän oppilailla oli keinoja itsensä rentouttamiseksi, päinvastoin kuin kontrolliryhmän oppilailla, joilla keinottomuuden kokemus jopa lisääntyi. Interventioryhmän oppilaat suhtautuivat hyvin kielteisesti toisen yllyttämiseen väkivaltaiseen tekoon ja kirjoittivat enemmän ajatuksiaan väkivallasta tuoden esille runsaasti ehdotuksia keinoista väkivallan vähentämiseksi. Myös oppilaat ja opettajat kokivat interventio-ohjelman oppilaiden kehityksen kannalta hyödylliseksi ja opettajat myös interventiomateriaalin käyttökelpoiseksi.

Performance improvement in mediterranean operations using risk management analysis : Case study of Containerships Group Ltd

Emerging markets of Northern Africa and Turkey provide growth opportunities for logistics service companies in the middle of low growth environment of European Union. The purpose of this research is to explore and analyze the risk factors in container shipping industry and third party logistics (3PL) services. The research empirically examined the risk factors, which are related within the interaction between these two parties in emerging markets of Mediterranean area. The previous studies have provided a valuable insight into the operational risks faced by container shipping industries. However, most of these studies have focused on one or several operational risk factors from a single point of view, and no studies have inclusively examined the possible operational risks faced in the container shipping industry from dual perspective of 3PL provider and its customers. A questionnaire has been deployed to collect related data; and the impacts of the risks were then be assessed and ranked using the method of risk mapping. Respondents were located in Turkey, Algeria, Tunisia, and Libya. Research presents the most important risk factors identified, and compares them between 3PL provider and its customers. The research also provide some risk mitigation strategies for the key risk factors, and tried to figure out a common risk picture, which guides the managers in both sides to have a better decisions and as a result, improve the performance of the container shipping operations. Challenge during project execution time was that customers identified vast amount of more risks than what was the case with logistics service operator.

Improvement of Energy Efficiency in a Gold Mining Industry: Case Study of a Russian Gold Mining Company

The issue of energy efficiency is attracting more and more attention of academia, business and policy makers worldwide due to increasing environmental concerns, depletion of non-renewable energy resources and unstable energy prices. The significant importance of energy efficiency within gold mining industry is justified by considerable energy intensity of this industry as well as by the high share of energy costs in the total operational costs. In the context of increasing industrial energy consumption energy efficiency improvement may provide significant energy savings and reduction of CO2 emission that is highly important in order to contribute to the global goal of sustainability. The purpose of this research is to identify the ways of energy efficiency improvement relevant for a gold mining company. The study implements single holistic case study research strategy focused on a Russian gold mining company. The research involves comprehensive analysis of company’s energy performance including analysis of energy efficiency and energy management practices. This study provides following theoretical and managerial contributions. Firstly, it proposes a methodology for comparative analysis of energy performance of Russian and foreign gold mining companies. Secondly, this study provides comprehensive analysis of main energy efficiency challenges relevant for a Russian gold mining company. Finally, in order to overcome identified challenges this research conceives a guidance for a gold mining company for implementation of energy management system based on the ISO standard.

A physical activity intervention in a workplace setting

Physical inactivity poses a huge burden on Canada's health care system and is detrimental to the health of Canadians (Katzmarzyk & Janssen, 2004). Walking is a viable option for individuals to become physically active on a daily basis and is in fact the most commonly reported leisure time physical activity. It has been associated with many health benefits including weight loss/weight control, reduced risk of coronary artery disease and diabetes, lowered blood pressure, and improved psychological wellbeing (Brisson & Tudor-Locke, 2004). Specifically, individuals' stage of change, selfefficacy and health related quality of life (HRQL) are three psychological constructs that can be greatly improved with increased physical activity (Dishman, 1991; Penedo & Dahn, 2005; Poag & McAuley, 1992). Public health physical activity recommendations exist but many individuals find these difficult to meet due to overly busy lifestyles (Public Health Agency of Canada, 2003). Pedometers are inexpensive devices that can monitor individual bouts of walking so that the incorporation of physical activity into one's daily life is more plausible. They are also excellent tools for motivation, goalsetting, and immediate feedback (Brisson & Tudor-Locke, 2004). Since many people spend a large proportion of their time at their places of employment, workplaces have begun to be a common site for the development of physical activity interventions. These programs have been growing in popUlarity and have shown numerous benefits for both employees and employers (Voit, 2001). The purpose of the current study was to implement and evaluate the use of a pedometer-based physical activity intervention incorporating goal-setting and physical activity logs in a workplace setting, and to examine the relationship between different types of self-efficacy (task, barrier, and scheduling) and different phases of the intervention. Twenty male participants from a local steel manufacturing plant who exhibited health risk factors (e.g. hypertension, diabetes, etc.) were assigned to one of two groups (group A or group B). All participants were asked to wear pedometers on their waists, record their daily steps, set goals that were outlined on a step-tracking sheet (detennined by their baseline number of steps), and keep track of their work days, wakelbed time, sedentary time, and time spent doing other physical activity. Group A began the intervention immediately following the baseline measures, whereas group B continued with their regular routine for 4 weeks before beginning. Physiological measures (height, weight, blood pressure, relative body fat, waist and hip circumference, and body mass index) were taken and a battery of questionnaires that assessed barrier, task and scheduling self-efficacy, HRQL, and stage of change administered at baseline, week 5 (end of intervention for group A), week 9 (end of intervention for group B; follow-up for group A) and week 13 (follow-up for both groups). Results showed that this workplace physical activity intervention was successful at increasing the participants' daily steps, that task self-efficacy is a significant predictor of participants' exercise adherence during the initial stages of participation (intervention phase), and that the participants felt that this intervention was effective. Finally, further exploratory analyses showed that this intervention was effective for all participants, but most valuable for participants most in need of improvement - that is, those who were most sedentary prior to the intervention. This intervention is an inexpensive use of simple and effective tools (e.g. pedometers), has the potential to attract a wide variety of participants and become a pennanent part of any health promotion initiative.

What children value : a scale to guide health promotion programs

Objective. Physical activity is important for the health of all human beings. Although it is important to develop good health promotion programs for children to increase participation in physical activity, to date there appear to be no programs based on what kids value beyond health and physical activity itself. This study proposed to create a scale with strong content and face validity that could uncover what any given population of children value in life regardless of their participation in physical activity and that experts feel could be related to physical activity. These findings will allow the development of targeted health promotion programs to increase children's participation in regular physical activity. Method In this study, a combination of qualitative and quantitative approaches was used. Data were gathered from seven experts in the field, sixty-seven children in grades three to five, five parents, and three teachers. From these data response groupings were created and sent to four experts to be given single word names. The resulting nine theme names were re-worked into "child-friendly" language. Four children were then asked to discuss theme names to see if they liked and understood them. The next step involved asking children and experts to rank order the nine themes, the children in general and the experts in terms of relevance to physical activity. From these results, possible versions of the scale were then created using the combined expert/children rankings. Each version was examined for content validity. Two versions of a scale resulted. These were sent to experts, parents, teachers and children in order to determine which one they liked better and to suggest any foreseeable problems. Once this information was collected, a beta (final prototype) version of the scale was created. Results. Nine common theme names were created from the response groupings. All four children agreed that they did understand and like each of the nine theme names. Experts and teachers agreed that full coverage of the content had been achieved. Children suggested a single wording change from "Being Accepted" to "Being Included". Five themes were selected for inclusion. The beta version of the scale included 12 forced choice statements, the first ten comparing all themes against one another followed by two anchor statements. Conclusion. At the outset it was recognized that it is essential to know what children think is important in their lives in order to serve as potential benefits in the development of effective physical activity promotion programs. This study developed a scale which could be used to determine what a population of children feel is important in order to focus health promotion programs for physical activity. The scale has strong face and content validity.

Examining current facilitative practices and projections of activity-based physical education degree programs regarding the participation of individuals with disabilties /

Individuals with disabiliiies are increasingly accessing post secondary education opportunities to further develop their educational and career goals. This study examines the current facilitative practices of Canadian university activity-based physical education degree programs on the participation of individuals with disabilities. A critical orientation and descriptive/interpretative approach allows insight into unique stories and experiences of physical education practitioners and special needs professionals as they attempt to provide equitable educational experiences within a least restrictive environment. Leading practitioners are used to triangulate and strengthen the validity of the data while providing direction and advocacy for future development and inclusion of individuals with disabilities. The study concludes with seven recommendations, each providing university activity-based physical education degree programs with viable opportunities for helping create equitable opportunities for individuals with disabilities.