Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study

Background: Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability. Objective: While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested. Methods: This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened. Results: The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon. Conclusions: This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice.

A randomised controlled trial of calcium channel blockade (CCB) with Amlodipine For the treatment oF subcortical ischaEmic vasCular demenTia (AFFECT): study protocol

BACKGROUND: Vascular dementia is the second most common cause of dementia affecting over seven million people worldwide, yet there are no licensed treatments. There is an urgent need for a clinical trial in this patient group. Subcortical ischaemic vascular dementia is the most common variant of vascular dementia. This randomised trial will investigate whether use of calcium channel blockade with amlodipine, a commonly used agent, can provide the first evidence-based pharmacological treatment for subcortical ischaemic vascular dementia.

METHODS/DESIGN: This is a randomised controlled trial of calcium channel blockade with Amlodipine For the treatment oF subcortical ischaEmic vasCular demenTia (AFFECT) to test the hypothesis that treatment with amlodipine can improve outcomes for these patients in a phase IIb, multi-centre, double-blind, placebo-controlled randomised trial. The primary outcome is the change from baseline to 12 months in the Vascular Dementia Assessment Scale cognitive subscale (VADAS-cog). Secondary outcomes include cognitive function, executive function, clinical global impression of change, change in blood pressure, quantitative evaluation of lesion accrual based on magnetic resonance imaging (MRI), health-related quality of life, activities of daily living, non-cognitive dementia symptoms, care-giver burden and care-giver health-related quality of life, cost-effectiveness and institutionalisation. A total of 588 patients will be randomised in a 1:1 ratio to either amlodipine or placebo, recruited from sites across the UK and enrolled in the trial for 104 weeks.

DISCUSSION: There are no treatments licensed for vascular dementia. The most common subtype is subcortical ischaemic vascular dementia (SIVD). This study is designed to investigate whether amlodipine can produce benefits compared to placebo in established SIVD. It is estimated that the numbers of people with VaD and SIVD will increase globally in the future and the results of this study should inform important treatment decisions.

Gerenciamento de impressões e qualidade dos serviços em hotéis da Paraíba

The present study has got as its aim to show how the impressions management is being used by the hotels in Paraiba State. For that, the dramma or role play perspective has been adopted as a model for service management. From the theater metaphor, the physical environment and its components can be seen as a scenery of the service show. We conduct the reader to notice the importance of the consummer about the service quality demand and its influence on his satisfaction. A methodology with exploring and qualifying nature has been adopted by using the analyses of content technique in interviews applied to hotel managers lebeled as having 4 and 5 stars in the State, trying to check how impression management takes place, identifying impression management tools used in relation to the physical evidences and to contacting people, as well as checking managers views in the survey about the use of impression management for client satisfaction make. The information revealed that managers, maybe for being unaware about impression management theory, haven t considered neither the physical evidences yet, nor contacting people as marketing tools. About the physical evidences, we could see that hotels take actions in a pulverized way referring to environment decoration and colors, however there isn t a global usage of physical evidences to highlight the service. Contacting people by their turn, receive better importance and attention. It was possible to make sure that managers are aware about the influence of the employee over the attendance quality. This way, we may come into a conclusion that impression management at Paraiba hotels has been under used, as long as managers seem to be, most times, turned to actions related to contacting people, not having realized the planning importance and national-wide use of service scenery in a genaral way yet

Publication Bias

According to the Declaration of Helsinki, as well as the Statement on Public Disclosure of Clinical Trial Results of the World Health Organization, every researcher has the ethical obligation to publish research results on all trials with human participants in a complete and accurate way within 12 months after the end of the trial.1,2 Nevertheless, for several reasons, not all research results are published in an accurate way in case they are released at all. This phenomenon of publication bias may not only create a false impression on the reliability of clinical research business, but it may also affect the evidence of clinical conclusions about the best treatments, which are mostly based on published data and results.

The (Im)possibility of the Intellectual Worker Inside the Neoliberal University

The provocation and point of this paper is that universities of the North during the era of neoliberalism of have been sucked of their human life-giving capacities. What remains are closed doors and bare walls. Lest we give the impression of a hopelessly romantic view of the university (and embark upon a lament for some paradise lost), let us be clear from the outset: there is no such place – and there never has been. As will be outlined below, a consideration of the history of the university reveals it was born and has persistently drawn its life breath from oxygen formed in the tension ridden mix of an impulse to human freedom and accommodation to powers of church, state and capital. But, we contend, history is now the witness to the almost complete dissolution of that tension: to the exhaustion of emancipatory impulses in the service of indoctrination, regulation and accumulation. In the church-state-capital triad, it is the latter that has emerged hegemonic. Importantly, we argue, its dominance has emerged with the rise of what Paul Baran and Paul Sweezy describe as monopoly capital: the move from competitive (small entrepreneurial business) forms to monopolistic (large corporate business) regimes of accumulation (Baran & Sweezy 1966). A central feature of monopoly capitalism is its need for significant financial support of national states and the harnessing of public resources such as universities to feed accumulation. It is no surprise that neoliberalism, despite its neoclassical economic pronouncements, is a ‘big state’ advocate (Harvey 2005). Our argument is that neoliberalism, as the political workhorse of monopoly capitalism, has overseen a makeover of universities so they might behave like a monopoly capitalist corporation. Our time is the time of the near global domination of capital. The university has succumbed. In its colonisation – its capitalisation – the university has not only reinvented itself as a willing ally of capital but has also set about remaking itself in its image.

Voyage au coeur de la prédation entre vendeurs et acheteurs : une nouvelle théorie en vente et marketing

Résumé : II existe une tension inhérente au sein de la relation en cours de développement entre un vendeur et un acheteur. Le vendeur craint que l'acheteur lui fasse perdre son temps et l'acheteur, lui, doute de l'honnêteté du vendeur. Tous deux s'interrogent sur le niveau de confiance et de coopération à accorder à l'autre. Il est possible, après tout, que le vendeur soit à l'affût de la moindre faiblesse de l'acheteur pour profiter de la situation et s'enrichir à ses dépens, ou, vice-versa, que l'acheteur cherche à profiter du vendeur. La présente thèse examine les tensions entre vendeurs et acheteurs en ayant recours à la théorie enracinée élargie, qui comprend une série de boucles investigatrices formées de revues des écrits scientifiques et de cueillettes de données qualitatives et quantitatives. Elle cherche à démontrer que la prédation perçue (l'impression que l'autre abuse de nous de manière coordonnée) affecte négativement la bonne entente entre les parties prenantes de la transaction. La thèse suggère aussi que le phénomène de prédation existe dans toutes les sphères d'activités humaines, y compris dans le domaine juridique. Le modèle PARDU (prédateur-proie) initialement développé pour discuter du phénomène de prédation débouche, au fil de la recherche, sur le modèle OPERA et la grille MESLY®, qui offrent des applications pratiques pour mieux gérer la prédation informationnelle.||Abstract : There is an inherent tension between a seller and a buyer as their relationship progresses towards closing the deal. The salesperson fears that the buyer wastes his time, which he could otherwise spend towards real potential buyers. The buyer questions the sincerity of the salesperson. Both evaluate the amount of trust and coopération they should invest in the relationship. It is possible, after ail, that the salesperson wants to take advantage of every weakness he detects in the buyer in order to guarantee the sale, and it is equally possible that the buyer tries to fool the salesperson, with false credit information for example. This thesis examines tensions that exist between salespeople and buyers by using an extended version of grounded theory, by which date is collected and analysed both qualitatively and quantitatively. It demonstrates that perceived prédation reduces considerably the quality of the relationship. The thesis suggests that the phenomenon of prédation exists in every sphere of human activity, including in the légal system. The PARDU Model (predator-prey) initially developed to discuss the phenomenon of predation evolves, as the research progresses, towards the OPERA Model and the MESLY® grid, which offer pratical tools to better manage informational predation.

Obtenção de concentrado proteico do farelo de arroz e avaliação das propriedades químicas e funcionais

Esta dissertação é composta por 5 artigos.

Educação em neurofisiologia da dor e exercício em adolescentes com dor cervical: um estudo piloto da sua efetividade

Enquadramento: A prevalência da dor cervical crónica em adolescentes está a aumentar. Estudos recentes têm comprovado a eficácia de programas de educação com base na neurofisiologia da dor e exercício na diminuição da dor, incapacidade, medo e ansiedade associados à dor crónica. Contudo, apesar deste tipo de programas apresentar resultados promissores em adultos, a sua aplicação e efetividade em populações mais jovens tem sido pouco estudada. Objetivos: Avaliar a efetividade de um programa de educação com base na neurofisiologia da dor associado a exercícios na dor cervical crónica em adolescentes na 1) frequência e intensidade da dor, 2) incapacidade associada, 3) capacidade de resistência dos músculos flexores e extensores profundos da cervical e estabilizadores da omoplata, 4) ansiedade e 5) catastrofização. Métodos: Um total de 43 adolescentes com idade entre os 15 e os 18 anos da Escola Secundária Dr. João Carlos Celestino Gomes participaram neste estudo. Foram avaliadas a intensidade, duração e frequência da dor cervical, a incapacidade associada e a resistência dos músculos flexores e extensores profundos da cervical e estabilizadores da omoplata através dos testes dos flexores e extensores profundos e estabilizadores da omoplata, respetivamente. Foram também avaliados os níveis de ansiedade, catastrofização e perceção de mudança através do Inventário de Ansiedade Estado-Traço, da Escala de Catastrofização da Dor e da Escala de Perceção Global de Mudança. Resultados: O número de participantes a referir dor na semana que precedeu a avaliação no grupo experimental reduziu em 28,5%. Verificou-se uma interação significativa entre o momento de avaliação (antes da intervenção vs após a intervenção) e o grupo (experimental vs. controlo) para as variáveis resistência dos flexores profundos e catastrofização e um efeito do momento e do grupo (mas não uma interação) para a dor, incapacidade, resistência dos músculos extensores e estabilizadores da omoplata e ansiedade traço (p<0.05). Dos 21 participantes do grupo experimental, 85,7% referiu mudanças significativas na Escala de Perceção Global de Mudança. Conclusão: A educação em neurofisiologia da dor é uma intervenção que poderá ser utilizada em adolescentes com dor crónica, com resultados significativos na redução da dor, melhoria da resistência muscular dos músculos flexores e extensores profundos da cervical e estabilizadores da omoplata e diminuição da catastrofização.

A importância da impressão funcional - técnica modelo modificado em prótese parcial removível de extremo livre

A Prótese Parcial Removível esquelética na reabilitação de pacientes edêntulos parciais tem sido uma opção acessível, rápida e viável de restabelecer a função estética e fonética dos dentes perdidos, porém a grande problemática em torno deste tipo de reabilitação está nos casos de extremos livres uni e bilaterais que dependem do rebordo residual para sustentação, devido à falta de pilar posterior que pode comprometer a retenção e principalmente a estabilidade da prótese que estará sujeita a deslocamentos constantes durante a dinâmica dos movimentos funcionais. Na literatura é relatado que todos os conhecimentos devem ser observados a quando da confecção deste tipo de prótese, as explicações e orientações como se comporta este tipo de prótese e os cuidados que o paciente tem que ter, e principalmente as condições biológicas dos tecidos de suporte são da responsabilidade do Médico Dentista o qual ao ter em conta e transmitir estes conhecimentos no momento do planeamento consegue assim minimizar os riscos de fracasso. A impressão funcional é de extrema importância para o sucesso da reabilitação com este tipo de prótese, mais especificamente a técnica do modelo modificado, que o objeto deste trabalho é realçar a sua utilização. Sendo de especial interesse para a Medicina Dentária pela necessidade e demanda do tratamento clínico, quanto para o ensino nas universidades. Dessa forma este trabalho visa mostrar a importância da impressão funcional na Prótese Parcial Removível esquelética de extremo livre, em especial o modelo modificado, pois ela visa obter melhor estabilidade, suporte e retenção para conseguir um melhor conforto para o paciente, mantendo a integridade do periodonto e dos dentes de apoio, obtendo assim um bom prognóstico e sucesso no procedimento realizado, como forma de fazer com que este procedimento responda tanto a expectativa do paciente como da equipe que a confecciona.

Personal branding practices of adolescents on Instagram

The aim of this bachelor’s thesis was to explore adolescents’ personal branding practices in the social media environment of the photo and video sharing mobile application Instagram. As the theoretical background for personal branding is quite limited, this thesis combined concepts of personal branding and self-presentation to answer the research problems. Empirical data was collected by conducting semi-structured individual interviews with 10-14-year-old adolescent girls. The photo-elicitation method was utilized in the interviews as the participants were requested to present and discuss their Instagram accounts. The concepts of personal brand identity and personal brand positioning were found to be suitable descriptions to adolescents’ personal branding practices on Instagram. It was found that adolescents consciously consider what kind of personal brand identity they aim to portray to their audience and that authenticity of the personal brand identity is valued. Personal brand positioning, on the other hand, was found to be achieved through impression management: adolescents make strategic disclosure decisions regarding the content they post on their Instagram accounts in a way that the content is reflective of the personal brand identity. Posting brand-related user-generated content on one’s Instagram account was found to be one of the many disclosure decisions in personal brand positioning on Instagram and this type of content was very common on the participants’ accounts. Adolescents were also found to be interested in monitoring the audience reactions to their personal branding efforts.

Las novelas de la nebulosa y lo ominoso

[es] El concepto freudiano de Das Unheimliche, «lo ominoso», también conocido en español como «lo siniestro», es un fenómeno complejo del inconsciente de la psique humana. Comprende el inquietante momento de inseguridad al ver la inesperada metamorfosis de lo familiar y conocido en otra cosa. Este fenómeno no solo se evidencia en la vida real, sino también con mucha frecuencia en el arte y la literatura. Un escritor cuya creación ofrece un excelente ejemplo para estudiar la presencia de las teorías freudianas, en especial la de lo ominoso en la literatura, es el autor vanguardista español Ramón Gómez de la Serna. El escritor usó a menudo la técnica de impresión de lo siniestro en las novelas de la nebulosa: El incongruente (1922), El novelista (1923), ¡Rebeca! (1936) y El hombre perdido (1947). [en] The Freudian concept of the uncanny is a phenomenon as complex as interesting of the unconscious of the human psyche which comprises the disturbing moment of insecurity of seeing the unexpected metamorphosis of the familiar and known to the unknown. This phenomenon is evident not only in real life, but very often in art and literature. A writer whose creation provides an excellent example for the presence of Freud’s theories, especially the uncanny in the literature, is the avant-garde Spanish author Ramón Gómez de la Serna. The writer often used the impression of uncanny; a trend that stands in the novels of the nebula, which are rich in uncanny themes: El incongruente (1922), El novelista (1923), ¡Rebeca! (1936) and El hombre perdido (1947).

B2B-palveluprosessin analyysi ja myyntikohtaamisen kehityskohteet uusasiakashankinnassa

Tämän opinnäytetyön tavoitteena on selvittää tekijöitä, jotka vaikuttavat myyntikohtaamisen onnistumiseen potentiaalisten yritysasiakkaiden keskuudessa. Käytännön ratkaisuihin pääsemiseksi opinnäytetyössä tarkastellaan case-yritystä, joka on suomalainen vakuutusyhtiö. Tutkimus keskittyy case-yrityksen palveluprosessin tarkasteluun, sekä käytännön myyntikohtaamisen analysoimiseen. Tutkimuksen avulla pyritään muodostamaan näkemys siitä, mitä myyntikohtaamisessa kannattaa kehittää, jotta uusasiakashankintaa voitaisiin yrityksen toimintona parantaa. Myyntikohtaamista ja laajempaa palveluprosessia tarkastellaan aluksi case-yrityksen toimintamallien kautta. Keskeisessä roolissa on asiakaslähtöisen toimintaperiaatteen selventäminen teoriassa ja sen vertaaminen case-yrityksen koko palveluprosessin toimintamalleihin. Tämän jälkeen siirrytään tarkastelemaan haastattelututkimuksen avulla kerättyä dataa case-yrityksen asiakkailta. Haastattelututkimuksen avulla selvitettiin myyntikohtaamisen toteutumista käytännössä. Opinnäytetyössä selvisi, että case-yrityksen toimintamallit on rakennettu asiakaslähtöisiä periaatteita noudattaen. Myös käytännön myyntikohtaamisessa asiakaslähtöisyys toteutuu laajalti, mutta muutamia kehityskohteita etenkin ensikontaktin ja asiakkaan yksilöllisen informoinnin osalta on löydettävissä. Lisäksi case-yrityksen suositellaan kiinnittävän huomiota myyjien itsevarmuuden lisäämiseen, joka parantaa työtyytyväisyyttä, myyjien toimintavapautta ja mahdollistaa asiakaslähtöisyyden kumpuamisen organisaatiosta asiakkaalle. Opinnäytetyö jättää tilaa jatkotutkimukselle. Etenkin case-yrityksen osalta olisi suositeltavaa järjestää työtyytyväisyyskysely B2B-myyntitiimin keskuudessa, jotta toimintaa voitaisiin kehittää sisäisesti. Opinnäytetyön kehitysehdotusten pohjalta case-yritys voi myös kohdistaa lisätutkimusta asiakkaiden kokemuksiin, ja selvittää laajemman kyselyn avulla seikkoja, joita asiakkaat toivovat yritykseltä.

Determinantes da legibilidade e compreensibilidade dos relatórios de gestão de risco: evidência nas empresas cotadas portuguesas

O presente trabalho pretende analisar a divulgação do risco nos relatórios anuais das empresas portuguesas não financeiras, com valores cotados em bolsa. No momento em que vivemos, com toda esta instabilidade, os investidores e outros stakeholders estão cada vez menos confiantes e mais exigentes. Assim, relatar informação sobre risco, começa a ser um dos meios utilizados pelas empresas para transmitir confiança e viabilidade ao exterior. Contudo, será que uma empresa que divulga sobre risco é uma empresa que se encontra totalmente sã, e que não oculta nem ofusca qualquer tipo de informação? O objetivo deste trabalho passará por apurar, se de alguma forma, os gestores se fazem valer das estratégias de impression management para ocultar ou, ofuscar os stakeholders na divulgação de informações sobre risco. Para o desenvolvimento desta investigação tivemos por base as empresas cotadas na Euronext Lisbon, para as quais foi efetuada uma análise de conteúdo do Relatório de Gestão, do Anexo e do Relatório do Governo das Sociedades, nos anos de 2007, 2010 e 2013. Aos dados recolhidos aplicou-se o modelo de regressão OLS, confirmando a hipótese do índice de compreensibilidade estar associado positivamente com a dimensão da empresa. Dos resultados obtidos concluiu-se ainda a existência de uma associação negativa entre o índice de legibilidade e a dimensão e o setor de atividade.

Estudo sobre a participação de roedores na cadeia de transmissão de Leishmania infantum (Protozoa: Trypanosomatidae) no Rio Grande do Norte

American visceral leishmaniasis is a zoonosis caused by Leishmania infantum and transmitted by the bite of the sand flies Lutzomia longipalpis.The main domestic reservoir is the dog, while foxes and opposums are the known wild reservoirs. However, identification of natural infections with L. infantum in rodents appears for need of investigating the participation of these rodents how source of infection of the parasite. In the present work the Leishmania infantum infection was investigated in rodents captured in Rio Grande do Norte, aiming at to offer subsidies to the understanding of the epidemic chains of LVA in the State. Thirteen Galea spixii were distributed in four groups, being G1 the group control with four animals and the others, G2, G3 and G4, with three animals each. Those animals were intraperitoneally inoculated with 107 promastigotas of L. infantum and accompanied for, respectively, 30, 90 and 180 days. Weekly the animals were monitored as for the corporal weight and rectal temperature. At the end of each stipulated period the animals were killed. Blood were used for determination of the parameters biochemical and haematological, PCR, ELISA, microscopic examination and cultivation in NNN medium. Liver, spleen and lymph node were used in Giemsa-stained impression and cultivation in NNN medium. Liver and spleen fragments were still used in PCR and histopathological, respectively. At the same time 79 rodents of the species Rattus rattus, Bolomys lasiurus, Oligoryzomys nigripis, Oryzomys subflavus and Trichomys apereoides were captured in the Municipal districts of Brejinho, Campo Grande, Coronel Ezequiel, Passa e Fica and Vázea for identification of natural infection with L. infantum. Evidence of infection was checked by direct examination of Giemsa-stained impression of liver, spleen and blood and culture of these tissues in NNN medium. Antibodies were researched by ELISA. They were not found differences among the weigh corporal final, rectal temperature and biochemical and haematological parameters of the Galea spixii controls and infected. The rectal temperature of the animals varied from 36OC to 40OC. For the first time values of the haematocrit (33,6% to 42,8%), hemoglobin (10,2 to 14,5g/dl), erythrocyts number (4,67x106 to 6,90x106/mm3), total leukocytes (0,9x103 to 9,2x103/mm3), platelets (49x103 to 509x103/mm3) total proteins (1,56 to 6,06 g/dl), albumin (1,34 to 3,05 g/dl) and globulins (0,20 to 3,01 g/dl) of the Galea spixii were determined. The lymphocytes were the most abundant leucocytes. Infection for L. infantum was diagnosed in two animals euthanasied 180 days after the infection. In one of the animals was also identified antibodies anti-Leishmania. The parasite was not found in none of the five other species of rodents captured. Galea spixii are resistant to the infection for L. infantum and they are not good models for the study for visceral leishmaniose, although they can act as infection sources. More studies are necessary to determine the paper of the rodents in the epidemic chain of transmission of the visceral leishmaniose in the State of Rio Grande do Norte