Supportive care needs of people with brain tumours and their carers

Goals of work: The diagnosis and treatment of a brain tumour may result in long-term changes in a patient's functional and social abilities and/or in a greatly reduced life span. A qualitative investigation was conducted to examine the supportive care needs of patients with brain tumour and their carers. Materials and methods: Overall, 18 patients and 18 carers participated in focus groups or telephone interviews, following a structured interview guide to elicit supportive care services of importance to these patients and carers. Main results: Six major themes were identified using the framework analysis method, including needs for information and coping with uncertainty, practical support, support to return to pretreatment responsibilities or prepare for long-term care, support to deal with social isolation and organize respite care, support to overcome stigma/discrimination and support to discuss potentially reduced life expectancy. Conclusions: Five recommendations to improve service delivery include: assignment of a dedicated member of the care team or case manager; proactive dissemination of information, education and psychosocial support; access to objective assessment of neuropsychological functioning; facilitating easier access to welfare payments; and services facilitating communication about difficult illness-related topics. Provision of services along these recommendations could improve supportive care of brain tumour patients and their carers.

Compositional analysis of teas from Australian supermarkets

Caffeine, total amino acids, water extract and moisture content are considered to be quality indicators for leaf teas and teabags. These analyses were examined in 20 leaf teas and 36 teabags sampled from Australian supermarkets. About 70% of the analysed samples showed a moisture content higher than Vie maximum accepted level, 6.5%, for tea storage and marketing by the tea industries and traders. Water appropriate extract of 15 samples out of 36 teabags was lower than that of the teas without teabags, which indicates that the quality of the paper used for teabags needs to be evaluated. Moreover, one of the black leaf tea samples was found to have a water extract below the lower limit of international standards. Four green and black teas of the same brand, claimed to contain less than 3% caffeine, were found to have 3-4%, the same as the other samples analysed in this study. The mean total contents of amino acids were 2.50% and 1.76% in black leaf teas and the teabags, respectively, whereas they were 3.44% and 2.28% in green leaf teas and the teabags, respectively. Furthermore, the weights of 28 teabags out of 36 samples were found to lie outside of the proposed +/- 2% variation accepted by the tea industries and traders, and 4 samples showed even larger variation, 10% being out of the proposed weights. This investigation also showed that the solubility of caffeine and water extract was affected by the permeability of teabags, whereas total amino acids were very variable. These results suggest that an efficient and practical quality control system for both imported and Australian-made teas in the Australian supermarkets should be developed, implemented and enforced. Chemical analysis should be a part of the system for establishing an objective assessment for the quality control. (c) 2004 Elsevier Ltd. All rights reserved.

The electroretinogram:a useful tool for evaluating age-related macular disease?

With an ageing population, the number of age-related macular disease (ARMD) cases will inevitably rise. This gives greater impetus for the need to identify the disease earlier and assess treatments to slow disease progression. Differing electroretinogram (ERG) modalities have been reviewed in relation to the objective assessment of retinal function in ARMD and for monitoring the effectiveness of clinical interventions. Conflicting results have been found with regard to the efficacy of ERG findings in the investigation of ARMD in previous years. The newer multifocal ERG paradigm provides spatial topographical information about retinal function in ARMD. It has shown promising results in monitoring effectiveness of clinical interventions and studies are continuing in this area. Better knowledge of retinal function in ARMD may lead to enhanced treatments at each phase of the disease.

Ocular response to silicone-hydrogel contact lenses

The thesis investigates the ocular response to silicone-hydrogel (SiH) contact lens wear, a relatively new contact lens material that has a higher modulus of rigidity and different surface coating than used in conventional hydrogel materials. The properties of SiH materials differ significantly from conventional hydrogels and, using subjective and objective means of assessment, the thesis examines how these properties affect reflection and biometry, ocular physiology, tear film characteristics, symptomatology, adverse events and complications. A range of standard and newly designed investigative techniques were employed, and latter involving novel imaging techniques, for the objective assessment of physiological changes which occur with contact lens wear. The study is the first to combine these techniques with biochemical analyses of the tear film composition. Forty-seven subjects were fitted with SiH lenses and randomly allocated to one of the two materials currently on the market (Lotrafilcon A or Balafilcon A) on an either daily or continuous wear basis. An additional control group of 14 age-matched non-contact lens wearers were monitored over the same period. Measurements were taken before and 1, 3, 6, 12 and 18 months after initial fitting. The findings reported in this thesis will enable contact lens practitioners and manufacturers to understand further the optical, physiological and biochemical nature of the ocular response to SiH contact lenses and hence facilitate the development of this important generation of contact lens material.

Nidek OPD-scan analysis of normal, keratoconic, and penetrating keratoplasty eyes

PURPOSE: To determine by wavefront analysis the difference between eyes considered normal, eyes diagnosed with keratoconus, and eyes that have undergone penetrating keratoplasty METHODS: The Nidek OPD-Scan wavefront aberrometer was used to measure ocular aberrations out to the sixth Zernike order. One hundred and thirty eyes that were free of ocular pathology, 41 eyes diagnosed with keratoconus, and 8 eyes that had undergone penetrating keratoplasty were compared for differences in root mean square value. Three and five millimeter root mean square values of the refractive power aberrometry maps of the three classes of eyes were compared. Radially symmetric and irregular higher order aberration values were compared for differences in magnitude. RESULTS: Root mean square values were lower in eyes free of ocular pathology compared to eyes with keratoconus and eyes that had undergone penetrating keratoplasty. The aberrations were larger with the 5-mm pupil. Coma and spherical aberration values were lower in normal eyes. CONCLUSION: Wavefront aberrometry of normal, pathological, and eyes after surgery may help to explain the visual distortions encountered by patients. The ability to measure highly aberrated eyes allows an objective assessment of the optical consequences of ocular pathology and surgery. The Nidek OPD-Scan can be used in areas other than refractive surgery.

Compétences en littératie visuelle chez les étudiantEs en biologie au niveau collégial: bilan des apprentissages selon des activités digitales ou des activités de dessins à la main

This study examines the role of visual literacy in learning biology. Biology teachers promote the use of digital images as a learning tool for two reasons: because biology is the most visual of the sciences, and the use of imagery is becoming increasingly important with the advent of bioinformatics; and because studies indicate that this current generation of teenagers have a cognitive structure that is formed through exposure to digital media. On the other hand, there is concern that students are not being exposed enough to the traditional methods of processing biological information - thought to encourage left-brain sequential thinking patterns. Theories of Embodied Cognition point to the importance of hand-drawing for proper assimilation of knowledge, and theories of Multiple Intelligences suggest that some students may learn more easily using traditional pedagogical tools. To test the claim that digital learning tools enhance the acquisition of visual literacy in this generation of biology students, a learning intervention was carried out with 33 students enrolled in an introductory college biology course. The study compared learning outcomes following two types of learning tools. One learning tool was a traditional drawing activity, and the other was an interactive digital activity carried out on a computer. The sample was divided into two random groups, and a crossover design was implemented with two separate interventions. In the first intervention students learned how to draw and label a cell. Group 1 learned the material by computer and Group 2 learned the material by hand-drawing. In the second intervention, students learned how to draw the phases of mitosis, and the two groups were inverted. After each learning activity, students were given a quiz on the material they had learned. Students were also asked to self-evaluate their performance on each quiz, in an attempt to measure their level of metacognition. At the end of the study, they were asked to fill out a questionnaire that was used to measure the level of task engagement the students felt towards the two types of learning activities. In this study, following the first testing phase, the students who learned the material by drawing had a significantly higher average grade on the associated quiz compared to that of those who learned the material by computer. The difference was lost with the second “cross-over” trial. There was no correlation for either group between the grade the students thought they had earned through self-evaluation, and the grade that they received. In terms of different measures of task engagement, there were no significant differences between the two groups. One finding from the study showed a positive correlation between grade and self-reported time spent playing video games, and a negative correlation between grade and self-reported interest in drawing. This study provides little evidence to support claims that the use of digital tools enhances learning, but does provide evidence to support claims that drawing by hand is beneficial for learning biological images. However, the small sample size, limited number and type of learning tasks, and the indirect means of measuring levels of metacognition and task engagement restrict generalisation of these conclusions. Nevertheless, this study indicates that teachers should not use digital learning tools to the exclusion of traditional drawing activities: further studies on the effectiveness of these tools are warranted. Students in this study commented that the computer tool seemed more accurate and detailed - even though the two learning tools carried identical information. Thus there was a mismatch between the perception of the usefulness of computers as a learning tool and the reality, which again points to the need for an objective assessment of their usefulness. Students should be given the opportunity to try out a variety of traditional and digital learning tools in order to address their different learning preferences.

Improvement of The Driver Simulator Control and Comparison Between Driver-Road-Vehicle Interaction in Real and Simulated Environment

The present doctoral thesis discusses the ways to improve the performance of driving simulator, provide objective measures for the road safety evaluation methodology based on driver’s behavior and response and investigates the drivers' adaptation to the driving assistant systems. The activities are divided into two macro areas; the driving simulation studies and on-road experiments. During the driving simulation experimentation, the classical motion cueing algorithm with logarithmic scale was implemented in the 2DOF motion cueing simulator and the motion cues were found desirable by the participants. In addition, it found out that motion stimuli could change the behaviour of the drivers in terms of depth/distance perception. During the on-road experimentations, The driver gaze behaviour was investigated to find the objective measures on the visibility of the road signs and reaction time of the drivers. The sensor infusion and the vehicle monitoring instruments were found useful for an objective assessment of the pavement condition and the drivers’ performance. In the last chapter of the thesis, the safety assessment during the use of level 1 automated driving “ACC” is discussed with the simulator and on-road experiment. The drivers’ visual behaviour was investigated in both studies with innovative classification method to find the epochs of the distraction of the drivers. The behavioural adaptation to ACC showed that drivers may divert their attention away from the driving task to engage in secondary, non-driving-related tasks.

The effect of structural fund spending on the spanish regions: an assessment of the 1994-99 objective 1 CSF

This paper analyzes the growth and employment effects of the 1994-99 Community Support Framework (CSF) for the Objective 1 Spanish regions using a simple supply-side model estimated with a panel of regional data. The results suggest that the impact of the Structural Funds in Spain has been quite sizable, adding around a percentage point to annual output growth in the average Objective 1 region and 0.4 points to employment growth. Over the period 1994-2000, the Framework has resulted in the creation of over 300,000 new jobs and has eliminated 20% of the initial gap in income per capita between the assisted regions and the rest of the country.

Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.

Background Delirium is an independent predictor of increased length of stay, mortality, and treatment costs in critical care patients. Its incidence may be underestimated or overestimated if delirium is assessed by using subjective clinical impression alone rather than an objective instrument. Objectives To determine frequency of discrepancies between subjective and objective delirium monitoring. Methods An observational cohort study was performed in a surgical-cardiosurgical 31-bed intensive care unit of a university hospital. Patients' delirium status was rated daily by bedside nurses on the basis of subjective individual clinical impressions and by medical students on the basis of scores on the objective Confusion Assessment Method for the Intensive Care Unit. Results Of 160 patients suitable for analysis, 38.8% (n = 62) had delirium according to objective criteria at some time during their stay in the intensive care unit. A total of 436 paired observations were analyzed. Delirium was diagnosed in 26.1% of observations (n = 114) with the objective method. This percentage included 6.4% (n = 28) in whom delirium was not recognized via subjective criteria. According to subjective criteria, delirium was present in 29.4% of paired observations (n = 128), including 9.6% (n = 42) with no objective indications of delirium. A total of 8 patients with no evidence of delirium according to the objective criteria were prescribed haloperidol and lorazepam because the subjective method indicated they had delirium. Conclusions Use of objective criteria helped detect delirium in more patients and also identified patients mistakenly thought to have delirium who actually did not meet objective criteria for diagnosis of the condition.

Continuous Assessment through Objective Structured Clinical Examinations in Veterinary Clinical Propaedeutics

Resumen basado en el de la publicaci??n

Nutritional biomarkers for objective dietary assessment

The accurate assessment of dietary exposure is important in investigating associations between diet and disease. Research in nutritional epidemiology, which has resulted in a large amount of information on associations between diet and chronic diseases in the last decade, relies on accurate assessment methods to identify these associations. However, most dietary assessment instruments rely to some extent on self-reporting, which is prone to systematic bias affected by factors such as age, gender, social desirability and approval. Nutritional biomarkers are not affected by these and therefore provide an additional, alternative method to estimate intake. However, there are also some limitations in their application: they are affected by inter-individual variations in metabolism and other physiological factors, and they are often limited to estimating intake of specific compounds and not entire foods. It is therefore important to validate nutritional biomarkers to determine specific strengths and limitations. In this perspective paper, criteria for the validation of nutritional markers and future developments are discussed.

Multi-objective evolutionary particle swarm optimization in the assessment of the impact of distributed generation

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

Portfolio: Objective structured examination for the assessment of essential competences at graduation

[EN] This porfolio is an Objective Structured Competence Examination (OSCE) designed for the Assessment of essentian competences defined by The European Asociation of Establishments for Veterinay Education (EAEVE) in its programme Evaluation of Veterinary Training in Europe

FAIR_OSCE – Feedback structure for assessment of interactive roleplay in Objective Structured Clinical Exams

Introduction Since the quality of patient portrayal of standardized patients (SPs) during an Objective Structured Clinical Exam (OSCE) has a major impact on the reliability and validity of the exam, quality control should be initiated. Literature about quality control of SPs’ performance focuses on feedback [1, 2] or completion of checklists [3, 4]. Since we did not find a published instrument meeting our needs for the assessment of patient portrayal, we developed such an instrument after being inspired by others [5] and used it in our high-stakes exam. Project description SP trainers from five medical faculties collected and prioritized quality criteria for patient portrayal. Items were revised twice, based on experiences during OSCEs. The final instrument contains 14 criteria for acting (i.e. adequate verbal and non-verbal expression) and standardization (i.e. verbatim delivery of the first sentence). All partners used the instrument during a high-stakes OSCE. SPs and trainers were introduced to the instrument. The tool was used in training (more than 100 observations) and during the exam (more than 250 observations). Outcome High quality of SPs’ patient portrayal during the exam was documented. More than 90% of SP performances were rated to be completely correct or sufficient. An increase in quality of performance between training and exam was noted. For example, the rate of completely correct reaction in medical tests increased from 88% to 95%. Together with 4% of sufficient performances these 95% add up to 99% of the reactions in medical tests meeting the standards of the exam. SP educators using the instrument reported an augmentation of SPs’ performance induced by the use of the instrument. Disadvantages mentioned were the high concentration needed to observe all criteria and the cumbersome handling of the paper-based forms. Discussion We were able to document a very high quality of SP performance in our exam. The data also indicates that our training is effective. We believe that the high concentration needed using the instrument is well invested, considering the observed enhancement of performance. The development of an iPad-based application for the form is planned to address the cumbersome handling of the paper.