A historical overview of leprosy epidemiology and control activities in Amazonas, Brazil

Leprosy is an ancient infectious disease caused by Mycobacterium leprae. According to comparative genomics studies, this disease originated in Eastern Africa or the Near East and spread with successive human migrations. The Europeans and North Africans introduced leprosy into West Africa and the Americas within the past 500 years. In Brazil, this disease arrived with the colonizers who disembarked at the first colonies, Rio de Janeiro, Salvador and Recife, at the end of the sixteenth century, after which it was spread to the other states. In 1854, the first leprosy cases were identified in State of Amazonas in the north of Brazil. The increasing number of leprosy cases and the need for treatment and disease control led to the creation of places to isolate patients, known as leprosaria. One of them, Colonia Antônio Aleixo was built in Amazonas in 1956 according to the most advanced recommendations for isolation at that time and was deactivated in 1979. The history of the Alfredo da Matta Center (AMC), which was the first leprosy dispensary created in 1955, parallels the history of leprosy in the state. Over the years, the AMC has become one of the best training centers for leprosy, general dermatology and sexually transmitted diseases in Brazil. In addition to being responsible for leprosy control programs in the state, the AMC has carried out training programs on leprosy diagnosis and treatment for health professionals in Manaus and other municipalities of the state, aiming to increase the coverage of leprosy control activities. This paper provides a historical overview of leprosy in State of Amazonas, which is an endemic state in Brazil.

An effective on-the-job training model-to facilitate strategy execution

Strategy execution has been a heated topic in the management world in recent years. However, according to a survey done by the Conference Board (2014), the chief executives are so concerned about the execution in their companies and have rated it as the No.1 or No.2 most challenging issue. Many of them choose to invest in training with a purpose to harvest the most for strategy execution. Therefore, this research is trying to find out a model to design training programs that can at most contribute to the success of strategy execution with three real-life training cases done by BTS Consulting Service. It was found that strategy execution could be greatly supported by training programs that take into consideration the four factors, namely Alignment, Mindset to Change, Capability and Organization Support. Main implications of the findings are presented and discussed. Key

Benefits of exercise training in the treatment of heart failure: study with a control group

OBJECTIVE: Exercise training programs have been proposed as adjuncts to treatment of heart failure. The effects of a 3-month-exercise-training-program with 3 exercise sessions per week were assessed in patients with stable systolic chronic heart failure. METHODS: We studied 24 patients with final left ventricle diastolic diameter of 70±10mm and left ventricular ejection fraction of 37±4%. Mean age was 52±16 years. Twelve patients were assigned to an exercise training group (G1), and 12 patients were assigned to a control group (G2). Patients underwent treadmill testing, before and after exercise training, to assess distance walked, heart rate, systolic blood pressure, and double product. RESULTS: In G2 group, before and after 3 months, we observed, respectively distance walked, 623±553 and 561± 460m (ns); peak heart rate, 142±23 and 146± 33b/min (ns); systolic blood pressure, 154±36 and 164±26 mmHg (ns); and double product, 22211± 6454 and 24293±7373 (ns). In G1 group, before and after exercise, we observed: distance walked, 615±394 and 970± 537m (p<0.003) peak heart rate, 143±24 and 143±29b/min (ns); systolic blood pressure, 136±33 and 133±24 mmHg (ns); and double product, 19907± 7323 and 19115±5776, respectively. Comparing the groups, a significant difference existed regarding the variation in the double product, and in distance walked. CONCLUSION: Exercise training programs in patients with heart failure can bring about an improvement in physical capacity.

The pattern and Loci of training-induced brain changes in healthy older adults are predicted by the nature of the intervention.

There is enormous interest in designing training methods for reducing cognitive decline in healthy older adults. Because it is impaired with aging, multitasking has often been targeted and has been shown to be malleable with appropriate training. Investigating the effects of cognitive training on functional brain activation might provide critical indication regarding the mechanisms that underlie those positive effects, as well as provide models for selecting appropriate training methods. The few studies that have looked at brain correlates of cognitive training indicate a variable pattern and location of brain changes - a result that might relate to differences in training formats. The goal of this study was to measure the neural substrates as a function of whether divided attentional training programs induced the use of alternative processes or whether it relied on repeated practice. Forty-eight older adults were randomly allocated to one of three training programs. In the SINGLE REPEATED training, participants practiced an alphanumeric equation and a visual detection task, each under focused attention. In the DIVIDED FIXED training, participants practiced combining verification and detection by divided attention, with equal attention allocated to both tasks. In the DIVIDED VARIABLE training, participants completed the task by divided attention, but were taught to vary the attentional priority allocated to each task. Brain activation was measured with fMRI pre- and post-training while completing each task individually and the two tasks combined. The three training programs resulted in markedly different brain changes. Practice on individual tasks in the SINGLE REPEATED training resulted in reduced brain activation whereas DIVIDED VARIABLE training resulted in a larger recruitment of the right superior and middle frontal gyrus, a region that has been involved in multitasking. The type of training is a critical factor in determining the pattern of brain activation.

Unison or cacophony: postgraduate training in pathology in Europe.

With the free movement of people in the European Union, medical mobility has increased significantly. This is notably the case for disciplines for which shortage of well-trained staff has occurred. Pathology is among those specialties and effectively the discipline is confronted with a striking increase in mobility among trainees and qualified specialists. The presumption underlying unlimited mobility is that the competencies of the medical specialists in the European countries are more or less equal, including significant similarities in the postgraduate training programs. In order to assess whether reality corresponds with this presumption, we conducted a survey of the content and practice requirements of the curricula in the EU and affiliated countries. The results indicate a striking heterogeneity in the training program content and practice requirements. To name a few elements: duration of the training program varied between 4 and 6 years; the number of autopsies required varied between none at all and 300; the number of biopsies required varied between none at all and 15,000. We conclude that harmonization of training outcomes in Europe is a goal that needs to be pursued. This will be difficult to reach through harmonization of training programs, as these are co-determined by political, cultural, and administrative factors, difficult to influence. Harmonization might be attained by defining the general and specific competencies at the end of training and subsequent testing them through a test to which all trainees in Europe are subjected.

Iowa Values Fund and Business Assistance Programs 2007 Annual Report, 2007

Following is the 2007 Annual Report of the Iowa Values Fund (IVF 2005) and Business Assistance Programs covering activity during Fiscal Year 2007 (FY ‘07) and cumulative for the first four years of the Iowa Values Fund Programs. The IVF (2005) is the primary funding source for a menu of financial assistance programs the Iowa Department of Economic Development (IDED) offers as incentives to Iowa companies to expand here, to recruit new companies into Iowa and assist new entrepreneurial ventures. In addition to IDED the law appropriates IVF (2005) funds for economic development activities to the Board of Regents, the Departments of Cultural Affairs and Natural Resources and to Community Colleges for certain workforce training programs. In addition to the IVF (2005), IDED allocates a portion of Community Development Block Grant and Federal Emergency Stimulus funds and several tax credit programs, all of which are included in this report.

The development and pilot-testing of a training curriculum in adolescent medicine and health.

PURPOSE: To select and propose a set of knowledge, attitudes, and skills essential for the care of adolescents; to encourage the development of adolescent health multidisciplinary networks; and to set up training programs in as many European countries as possible. METHODS: The curriculum was developed by 16 physicians from 11 European countries with various professional specializations. In line with modern guidelines in medical education, it is a modular, flexible instrument which covers the main teaching areas in the field, such as basic skills (i.e. setting, rights and confidentiality, gender and cultural issues) as well as specific themes (i.e. sexual and reproductive health, eating disorders, chronic conditions). It consists of 17 thematic modules, each containing detailed objectives, learning approaches, examples, and evaluation methods. RESULT: Two international one-week summer schools were used to assess the feasibility and appropriateness of the curriculum. The overall evaluation was good, with most of the items surpassing three on a four-point Likert scale. However, it pointed to several aspects (process and content) which will need to be refined in the future, such as an increase in interactive sessions (role playing), and a better mix of clinical and public health issues.

Maximizing the Use of Roadway Weather Information Systems: Final Report, TR-404, 1998

This project was proposed as Phase I of a 2-phase program to evaluate the present use of weather information by Iowa Department of Transportation (IaDOT) personnel, recommend revised procedures, and then implement the resulting recommendations. Midway through Phase I (evaluation phase) the FORETELL project was funded. This project is a multi-state venture that engages the National Weather Service (NWS) and the Forecast Systems Laboratory of the National Oceanic and Atmospheric Administration and proposes to supplant the current weather information-generation and distribution system with an advanced system based on state-of-the-art technologies. The focus of the present project was therefore refined to consider use of weather data by IaDOT personnel, and the training programs needed to more effectively use these data. Results of the survey revealed that two major areas - training of personnel on use of data from whatever source and more precise information of frost formation - are not addressed in the FORETELL project. These aspects have been the focus of the present project.

Evolution of Gait Performance and Fear of Falling after a 10-Week Program of Exercise Training in Community Dwelling Older People

A pilot study was conducted to determine the effect of a 10-week, low intensity, exercise training program on fear of falling and gait in fifty (mean age 78.1 years, 79% women) community-dwelling volunteers. Fear of falling (measured by falls self-efficacy) and gait performance were assessed at baseline and one week after program completion. At follow-up, participants modestly improved their falls self-efficacy and gait speed. To investigate whether this effect differed according to participants' fear of falling, secondary analyses stratified by subject's baseline falls efficacy were performed. Subjects with lower than average falls efficacy improved significantly their falls efficacy and gait performance, while no significant change occurred in the others. Small but significant improvements occurred after this pilot training program, particularly in subjects with low baseline falls efficacy. These results suggest that measures of falls efficacy might be useful for better targeting individuals most likely to benefit from similar training programs.

Education and Training in Forensic Intelligence: a New Challenge

From recent calls for positioning forensic scientists within the criminal justice system, but also policing and intelligence missions, this paper emphasizes the need for the development of educational and training programs in the area of forensic intelligence, It is argued that an imbalance exists between perceived and actual understanding of forensic intelligence by police and forensic science managers, and that this imbalance can only be overcome through education. The challenge for forensic intelligence education and training is therefore to devise programs that increase forensic intelligence awareness, firstly for managers to help prevent poor decisions on how to develop information processing. Two recent European courses are presented as examples of education offerings, along with lessons learned and suggested paths forward. It is concluded that the new focus on forensic intelligence could restore a pro-active approach to forensic science, better quantify its efficiency and let it get more involved in investigative and managerial decisions. A new educational challenge is opened to forensic science university programs around the world: to refocus criminal trace analysis on a more holistic security problem solving approach.

Evaluating End-User Training Effectiveness in ERP System Implementation

Today’s business world demands more and more internal and external integration and transparency among companies at all fields. Integrated ERP (enterprise resource planning) systems offer a possibility to improve business practices and procedures by providing a unified view on the business including all functions and departments. Due to the obvious benefits, the popularity of integrated ERP systems keeps growing. The implementation of ERP systems has however proven risky. The implementation projects tend to be long, extensive, and costly – and often they end up in a failure. Due to the significant task and role changes ERP implementation brings to almost everybody in the company, training has been identified as one of the most critical success factors of an ERP implementation. To ensure that the training is conducted in the most effective and successful manner, the training outcomes should be evaluated. So far, training evaluation has however gained only limited attention at most companies investing in different training programs. Uponor corporation has initiated a large ERP implementation and process harmonization program in 2004. Thousands of end-users have been trained during this project so far, and the work still continues until the project is completed in 2010. In this thesis, the evaluation of end-user training in Uponor’s ERP program is brought further from the current state of performing the basic participant satisfaction survey in the end of each class. The results show that in order to reach reliable training effectiveness evaluation results, not only the reaction towards training but also transfer of skills and attitudes and the final results of the training program should be evaluated.

Química Sem Fronteiras: o desafio da energia

Coal, natural gas and petroleum-based liquid fuels are still the most widely used energy sources in modern society. The current scenario contrasts with the foreseen shortage of petroleum that was spread out in the beginning of the XXI century, when the concept of "energy security" emerged as an urgent agenda to ensure a good balance between energy supply and demand. Much beyond protecting refineries and oil ducts from terrorist attacks, these issues soon developed to a portfolio of measures related to process sustainability, involving at least three fundamental dimensions: (a) the need for technological breakthroughs to improve energy production worldwide; (b) the improvement of energy efficiency in all sectors of modern society; and (c) the increase of the social perception that education is a key-word towards a better use of our energy resources. Together with these technological, economic or social issues, "energy security" is also strongly influenced by environmental issues involving greenhouse gas emissions, loss of biodiversity in environmentally sensitive areas, pollution and poor solid waste management. For these and other reasons, the implementation of more sustainable practices in our currently available industrial facilities and the search for alternative energy sources that could partly replace the fossil fuels became a major priority throughout the world. Regarding fossil fuels, the main technological bottlenecks are related to the exploitation of less accessible petroleum resources such as those in the pre-salt layer, ranging from the proper characterization of these deep-water oil reservoirs, the development of lighter and more efficient equipment for both exploration and exploitation, the optimization of the drilling techniques, the achievement of further improvements in production yields and the establishment of specialized training programs for the technical staff. The production of natural gas from shale is also emerging in several countries but its production in large scale has several problems ranging from the unavoidable environmental impact of shale mining as well as to the bad consequences of its large scale exploitation in the past. The large scale use of coal has similar environmental problems, which are aggravated by difficulties in its proper characterization. Also, the mitigation of harmful gases and particulate matter that are released as a result of combustion is still depending on the development of new gas cleaning technologies including more efficient catalysts to improve its emission profile. On the other hand, biofuels are still struggling to fulfill their role in reducing our high dependence on fossil fuels. Fatty acid alkyl esters (biodiesel) from vegetable oils and ethanol from cane sucrose and corn starch are mature technologies whose market share is partially limited by the availability of their raw materials. For this reason, there has been a great effort to develop "second-generation" technologies to produce methanol, ethanol, butanol, biodiesel, biogas (methane), bio-oils, syngas and synthetic fuels from lower grade renewable feedstocks such as lignocellulosic materials whose consumption would not interfere with the rather sensitive issues of food security. Advanced fermentation processes are envisaged as "third generation" technologies and these are primarily linked to the use of algae feedstocks as well as other organisms that could produce biofuels or simply provide microbial biomass for the processes listed above. Due to the complexity and cost of their production chain, "third generation" technologies usually aim at high value added biofuels such as biojet fuel, biohydrogen and hydrocarbons with a fuel performance similar to diesel or gasoline, situations in which the use of genetically modified organisms is usually required. In general, the main challenges in this field could be summarized as follows: (a) the need for prospecting alternative sources of biomass that are not linked to the food chain; (b) the intensive use of green chemistry principles in our current industrial activities; (c) the development of mature technologies for the production of second and third generation biofuels; (d) the development of safe bioprocesses that are based on environmentally benign microorganisms; (e) the scale-up of potential technologies to a suitable demonstration scale; and (f) the full understanding of the technological and environmental implications of the food vs. fuel debate. On the basis of these, the main objective of this article is to stimulate the discussion and help the decision making regarding "energy security" issues and their challenges for modern society, in such a way to encourage the participation of the Brazilian Chemistry community in the design of a road map for a safer, sustainable and prosper future for our nation.

Teaching project: a low-cost swine model for chest tube insertion training

Objective: to describe and evaluate the acceptance of a low-cost chest tube insertion porcine model in a medical education project in the southwest of Paraná, Brazil. Methods: we developed a low-cost and low technology porcine model for teaching chest tube insertion and used it in a teaching project. Medical trainees - students and residents - received theoretical instructions about the procedure and performed thoracic drainage in this porcine model. After performing the procedure, the participants filled a feedback questionnaire about the proposed experimental model. This study presents the model and analyzes the questionnaire responses. Results: seventy-nine medical trainees used and evaluated the model. The anatomical correlation between the porcine model and human anatomy was considered high and averaged 8.1±1.0 among trainees. All study participants approved the low-cost porcine model for chest tube insertion. Conclusion: the presented low-cost porcine model for chest tube insertion training was feasible and had good acceptability among trainees. This model has potential use as a teaching tool in medical education.

Effect of three exercise programs on patients with chronic obstructive pulmonary disease

We compared the effect of three different exercise programs on patients with chronic obstructive pulmonary disease including strength training at 50_80% of one-repetition maximum (1-RM) (ST; N = 11), low-intensity general training (LGT; N = 13), or combined training groups (CT; N = 11). Body composition, muscle strength, treadmill endurance test (TEnd), 6-min walk test (6MWT), Saint George's Respiratory Questionnaire (SGRQ), and baseline dyspnea (BDI) were assessed prior to and after the training programs (12 weeks). The training modalities showed similar improvements (P > 0.05) in SGRQ-total (ST = 13 ± 14%; CT = 12 ± 14%; LGT = 11 ± 10%), BDI (ST = 1.8 ± 4; CT = 1.8 ± 3; LGT = 1 ± 2), 6MWT (ST = 43 ± 51 m; CT = 48 ± 50 m; LGT = 31 ± 75 m), and TEnd (ST = 11 ± 20 min; CT = 11 ± 11 min; LGT = 7 ± 5 min). In the ST and CT groups, an additional improvement in 1-RM values was shown (P < 0.05) compared to the LGT group (ST = 10 ± 6 to 57 ± 36 kg; CT = 6 ± 2 to 38 ± 16 kg; LGT = 1 ± 2 to 16 ± 12 kg). The addition of strength training to our current training program increased muscle strength; however, it produced no additional improvement in walking endurance, dyspnea or quality of life. A simple combined training program provides benefits without increasing the duration of the training sessions.

Pressions et stratégies dans la formation professionnelle universitaire : le cas de la formation des directions d’établissement scolaire du Québec (1988-1989 à 2008-2009)

La multiplication des formations professionnelles universitaires (FPU) a poussé plusieurs chercheurs à s’intéresser aux caractéristiques de ces formations, leur perméabilité à une multitude de pressions étant l’une des plus fréquemment relevées. Ainsi, les unités responsables de FPU sont confrontées à des pressions diverses et souvent contradictoires. Si les écrits scientifiques sur les FPU témoignent bien de cette réalité, ceux-ci nous informent moins bien de la manière dont les unités responsables de ce type de formation répondent à ces pressions. Cette thèse a donc fait appel à plusieurs concepts de l’approche institutionnelle issue de la sociologie des organisations pour analyser l’évolution récente de la FPU destinée aux directions d’établissement scolaire (DES) du Québec, un champ qui a connu d’importantes transformations au cours des vingt-cinq dernières années. Construite sur une étude de cas interprétative dite à « unités enchâssées » (Yin, 2003), cette thèse s’est intéressée à l’évolution de cette formation dans deux unités universitaires francophones : le Département d’administration et fondements de l’éducation de l’Université de Montréal et le Département de gestion de l’éducation et de la formation de l’Université de Sherbrooke. Couvrant la période allant des années universitaires 1988-1989 à 2008-2009, elle repose sur une analyse du discours produit par les deux unités sélectionnées, et, dans une moindre mesure, par les organisations qui composent le champ organisationnel de la formation des DES au Québec. Pour ce faire, trois corpus documentaires distincts ont été assemblés et une série d’entrevues (dix par unités) ont été réalisées auprès d’informateurs-clés (doyens, directeurs de département/section, responsables de formation). Les résultats montrent comment ces unités tendent à se rendre isomorphes à leur environnement, et comment cela se fait en réponse à des pressions institutionnelles et de compétition diverses émanant d’un champ organisationnel en pleine transformation. En fait, poussée par des changements plus profonds touchant l’administration scolaire, cette transformation amène un champ organisationnel plus structuré, où les attentes concernant la FPU destinée aux DES sont plus explicites. Cela n’est pas sans conséquence sur l’évolution de la formation dans les deux unités. En effet, celle-ci connaît des changements importants, dont plusieurs convergent autour d’une logique de professionnalisation, d’un archétype spécifique de formation (un continuum de formation de 2e cycle, au cœur duquel se trouve un diplôme de deuxième cycle) et d’outils conséquents (conditions d’admission et populations étudiantes élargies; flexibilité dans la structure du programme et professionnalisation des activités; équipes enseignantes plus diversifiées). Les deux unités n’apparaissent cependant pas impuissantes devant ces pressions. Les résultats témoignent d’un certain niveau d’agence des deux unités, qui déploient un éventail de stratégies en réaction à ces pressions. Ces stratégies évoluent au cours de la période observée et visent surtout à gérer la situation de « pluralisme institutionnel » à laquelle elles sont confrontées, notamment entre les pressions externes de nature plus professionnalisantes, et les pressions intraorganisationnelles de nature plus académisantes. Ainsi, plusieurs des stratégies et tactiques composant la typologie d’Oliver (1991) ont été observées, les stratégies de compromis et de manipulation occupant, dans les deux unités, une place de plus en plus importante au gré de l’évolution du champ. La mise en œuvre de ces stratégies vise surtout à maintenir la légitimité de leur offre de formation devant des pressions plurielles et parfois contradictoires. Les résultats montrent aussi que la nature de l’entrepreneuriat institutionnel en place détermine en grande partie les stratégies qu’elles déploient. Cet « entrepreneuriat » est au cœur de l’évolution de la formation. Cependant, les résultats montrent aussi comment celui-ci est en partie contraint ou, a contrario, stimulé par les choix historiques qui ont été faits par les unités et leur université, et par l’empreinte et les dépendances de sentier qui en découlent. Ces résultats apportent un éclairage « institutionnaliste » sur la manière dont deux unités universitaires ont réagi, à une période donnée, aux pressions diverses provenant de leur environnement. Ils brossent un portrait complexe et nuancé qui vient à la fois (1) approfondir notre compréhension de cette spécificité des FPU, (2) approfondir notre compréhension de l’évolution récente de la FPU destinée aux DES québécoises, et (3) confirmer la puissance d’analyse de plusieurs concepts tirés de l’approche institutionnelle.