Listening to parents: The role of symptom perception in pediatric palliative home care.

OBJECTIVE: This study analyzes symptom perception by parents and healthcare professionals and the quality of symptom management in a pediatric palliative home care setting and identifies which factors contribute to a high quality of palliative and end-of-life care for children. METHODS: In this retrospective, cross-sectional study, parents were surveyed at the earliest three months after their child's death. All children were cared for by a specialized home pediatric palliative care team that provides a 24/7 medical on-call service. Questionnaires assessed symptom prevalence and intensity during the child's last month of life as perceived by parents, symptom perception, and treatment by medical staff. The responses were correlated with essential palliative care outcome measures (e.g., satisfaction with the care provided, quality-of-life of affected children and parents, and peacefulness of the dying phase). RESULTS: Thirty-eight parent dyads participated (return rate 84%; 35% oncological disorders). According to parental report, dyspnea (61%) and pain (58%) were the dominant symptoms with an overall high symptom load (83%). Pain, agitation, and seizures could be treated more successfully than other symptoms. Successful symptom perception was achieved in most cases and predicted the quality of symptom treatment (R 2, 0.612). Concordant assessment of symptom severity between parents and healthcare professionals (HCPs) improved the satisfaction with the care provided (p = 0.037) as well as the parental quality-of-life (p = 0.041). Even in cases with unsuccessful symptom control, parents were very satisfied with the SHPPC team's care (median 10; numeric rating scale 0-10) and rated the child's death as highly peaceful (median 9). Significance of the results: The quality and the concordance of symptom perception between parents and HCPs essentially influence parental quality-of-life as well as parental satisfaction and constitute a predictive factor for the quality of symptom treatment and palliative care.

Osakemarkkinoiden hintareaktiot luottoluokituksen muutokseen eri lainsäädäntöympäristössä

Tämän tutkielman tarkoituksena on selvittää reagoivatko osakemarkkinat eritavoin luottoluokituksen muutokseen eri lainsäädäntöympäristöissä. Lisäksi selvitetään myös reagoivatko pienten yhtiöiden osakekurssit erilailla luottoluokituksen muutokseen kuin suurten yhtiöiden osakekurssit. Tutkimusmenetelmänä käytetään tapahtumatutkimusta ja aineiston muodostavat Moody'sin luottoluokitusilmoitukset vuosilta 2000-2007. Tutkielman kohdemaina ovat Iso-Britannia, Ranska sekä Pohjoismaat Empiiristen tulosten perusteella ainoastaan luottoluokituksen laskun yhteydessä näyttää siltä, että lainsäädäntöympäristön ja markkinareaktion suuruuden välillä on oletetunkaltainen yhteys. Yrityskokoluokista puolestaan suurten yhtiöiden osakkeet reagoivat yleisesti voimakkaammin luottoluokituksen muutokseen kuin pienten yhtiöiden osakekurssit.

Disseny i implementació d'un sistema de control del grau de satisfacció dels clients dels serveis de restauració

Diseño de un sistema de control de la satisfacción a partir de las valoraciones a distintas empresas de restauración emitidas por clientes, inspectores y recopiladas de otras aplicaciones externas, que calcula una puntuación mensual a partir de una fórmula matemática que puede ir variando. Permite realizar consultas estadísticas relacionadas con las distintas valoraciones emitidas y las puntuaciones mensuales.

Uptake and factors that influence the use of ‘sit less, move more’ occupational intervention strategies in Spanish office employees

Background Little is known about the types of ‘sit less, move more’ strategies that appeal to office employees, or what factors influence their use. This study assessed the uptake of strategies in Spanish university office employees engaged in an intervention, and those factors that enabled or limited strategy uptake. Methods The study used a mixed method design. Semi-structured interviews were conducted with academics and administrators (n = 12; 44 ± 12 mean SD age; 6 women) at three points across the five-month intervention, and data used to identify factors that influenced the uptake of strategies. Employees who finished the intervention then completed a survey rating (n = 88; 42 ± 8 mean SD age; 51 women) the extent to which strategies were used [never (1) to usually (4)]; additional survey items (generated from interviewee data) rated the impact of factors that enabled or limited strategy uptake [no influence (1) to very strong influence (4)]. Survey score distributions and averages were calculated and findings triangulated with interview data. Results Relative to baseline, 67% of the sample increased step counts post intervention (n = 59); 60% decreased occupational sitting (n = 53). ‘Active work tasks’ and ‘increases in walking intensity’ were the strategies most frequently used by employees (89% and 94% sometimes or usually utilised these strategies); ‘walk-talk meetings’ and ‘lunchtime walking groups’ were the least used (80% and 96% hardly ever or never utilised these strategies). ‘Sitting time and step count logging’ was the most important enabler of behaviour change (mean survey score of 3.1 ± 0.8); interviewees highlighted the motivational value of being able to view logged data through visual graphics in a dedicated website, and gain feedback on progress against set goals. ‘Screen based work’ (mean survey score of 3.2 ± 0.8) was the most significant barrier limiting the uptake of strategies. Inherent time pressures and cultural norms that dictated sedentary work practices limited the adoption of ‘walk-talk meetings’ and ‘lunch time walking groups’. Conclusions The findings provide practical insights into which strategies and influences practitioners need to target to maximise the impact of ‘sit less, move more’ occupational intervention strategies.

A topical microemulsion for the prevention of allergic rhinitis symptoms: results of a randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial (Nares study)

Background: Since barrier protection measures to avoid contact with allergens are being increasingly developed, we assessed the clinical efficacy and tolerability of a topical nasal microemulsion made of glycerol esters in patients with allergic rhinitis. Methods: Randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial in which adult patients with allergic rhinitis or rhinoconjunctivitis due to sensitization to birch, grass or olive tree pollens received treatment with topical microemulsion or placebo during the pollen seasons. Efficacy variables included scores in the mini-RQLQ questionnaire, number and severity of nasal, ocular and lung signs and symptoms, need for symptomatic medications and patients" satisfaction with treatment. Adverse events were also recorded. Results: Demographic characteristics were homogeneous between groups and mini-RQLQ scores did not differ significantly at baseline (visit 1). From symptoms recorded in the diary cards, the ME group showed statistically significant better scores for nasal congestion (0.72 vs. 1.01; p = 0.017) and mean total nasal symptoms (0.7 vs. 0.9; p = 0.045). At visit 2 (pollen season), lower values were observed in the mini-RQLQ in the ME group, although there were no statistically significant differences between groups in both full analysis set (FAS) and patients completing treatment (PPS) populations. The results obtained in the nasal symptoms domain of the mini-RQLQ at visit 2 showed the highest difference (−0.43; 95% CI: -0.88 to 0.02) for the ME group in the FAS population. The topical microemulsion was safe and well tolerated and no major discomforts were observed. Satisfaction rating with the treatment was similar between the groups. Conclusions: The topical application of the microemulsion is a feasible and safe therapy in the prevention of allergic symptoms, particularly nasal congestion.

Validation of an instrument to evaluate quality of life in the aging population: WHOQOL-AGE.

BACKGROUND: There is a need for short, specific instruments that assess quality of life (QOL) adequately in the older adult population. The aims of the present study were to obtain evidence on the validity of the inferences that could be drawn from an instrument to measure QOL in the aging population (people 50+ years old), and to test its psychometric properties. METHODS: The instrument, WHOQOL-AGE, comprised 13 positive items, assessed on a five-point rating scale, and was administered to nationally representative samples (n = 9987) from Finland, Poland, and Spain. Cronbach's alpha was employed to assess internal consistency reliability, whereas the validity of the questionnaire was assessed by means of factor analysis, graded response model, Pearson's correlation coefficient and unpaired t-test. Normative values were calculated across countries and for different age groups. RESULTS: The satisfactory goodness-of-fit indices confirmed that the factorial structure of WHOQOL-AGE comprises two first-order factors. Cronbach's alpha was 0.88 for factor 1, and 0.84 for factor 2. Evidence supporting a global score was found with a second-order factor model, according to the goodness-of-fit indices: CFI = 0.93, TLI = 0.91, RMSEA = 0.073. Convergent validity was estimated at r = 0.75 and adequate discriminant validity was also found. Significant differences were found between healthy individuals (74.19 ± 13.21) and individuals with at least one chronic condition (64.29 ± 16.29), supporting adequate known-groups validity. CONCLUSIONS: WHOQOL-AGE has shown good psychometric properties in Finland, Poland, and Spain. Therefore, considerable support is provided to using the WHOQOL-AGE to measure QOL in older adults in these countries, and to compare the QOL of older and younger adults.

Brain Dopamine and Serotonin Receptors in the Perception of Pain. Positron Emission Tomography Studies in Healthy Subjects

The role of dopamine and serotonin in spinal pain regulation is well established. However, little is known concerning the role of brain dopamine and serotonin in the perception of pain in humans. The aim of this study was to assess the potential role of brain dopamine and serotonin in determining experimental pain sensitivity in humans using positron emission tomography (PET) and psychophysical methods. A total of 39 healthy subjects participated in the study, and PET imaging was performed to assess brain dopamine D2/D3 and serotonin 5-HT_1A receptor availability. In a separate session, sensitivity to pain and touch was assessed with traditional psychophysical methods, allowing the evaluation of potential associations between D2/D3 and 5-HT_1A binding and psychophysical responses. The subjects’ responses were also analyzed according to Signal Detection Theory, which enables separate assessment of the subject’s discriminative capacity (sensory factor) and response criterion (non-sensory factor). The study found that the D2/D3 receptor binding in the right putamen was inversely correlated with pain threshold and response criterion. 5-HT_1A binding in cingulate cortex, inferior temporal gyrus and medial prefrontal cortex was inversely correlated with discriminative capacity for touch. Additionally, the response criterion for pain and intensity rating of suprathreshold pain were inversely correlated with 5-HT_1A binding in multiple brain areas. The results suggest that brain D2/D3 receptors and 5-HT_1A receptors modulate sensitivity to pain and that the pain modulatory effects may, at least partly, be attributed to influences on the response criterion. 5-HT_1A receptors are also involved in the regulation of touch by having an effect on discriminative capacity.

La evaluación de la competencia de aprender a aprender

No es posible valorar la competencia de aprender a aprender directamente; sin embargo, podemos inferirla del desempeño de los alumnos ante determinadas tareas. Para ello es necesario dotarnos de indicadores de evaluación, así como del diseño de tareas auténticas

Psychological and Family Factors Associated with Suicidal Ideation in Pre-Adolescents

To assess the psychological and family factors associated with suicidal ideation in preadolescent children, we studied a sample of 361 students, average age 9 years old. Twogroups were formed, on the basis of the presence (n = 34) or absence (n = 44) of suicidal ideation. Suicidal ideation was assessed with the Children’s Depression Inventory and the Children’s Depression Rating Scale-Revised. Depression, hopelessness, self-esteem, and perceived family environment were compared in both the suicidal ideation and the control groups. Students with suicidal ideation generally presented greater depressive symptoms and hopelessness, and lower self-esteem and family expressiveness, although there weredifferences both between sexes, and when the variable depression was controlled. Identifying these risk factors in pre-adolescents may have an impact on prevention of suicidal behavior at higher risk ages

Rendimiento académico e inserción laboral de los titulados en medicina por la Universitat de Barcelona. Un estudio longitudinal

Introducción. El proceso de Bolonia ha provocado cambios en la estructura universitaria dando protagonismo a los conceptos de competencia y calidad. Esta situación planteó el reto de querer mostrar la contribución de la Universitat de Barcelona (UB) en la formación de médicos para la sociedad catalana y la distribución de estos titulados en relación a todo el colectivo de profesionales colegiados en la provincia de Barcelona. Sujetos y métodos. Estudio longitudinal de cuatro promociones de alumnos de la Facultad de Medicina de la UB, que ingresaron entre 1994 y 2001. Para cada cohorte se calcularon estadísticas de rendimiento académico, de formación especializada y de colegiación después de consultar diferentes bases de datos y utilizando el programa informático R. Resultados. El 85-96% de los alumnos que ingresaron en la Facultad de Medicina obtuvieron el título de licenciado en un plazo inferior a siete años. Del total de licenciados, un 83% constaba registrado en el colegio oficial de médicos de la provincia (COMB). Comparadas con la población colegiada de profesionales, estas promociones destacan por una tasa de feminización mayor (tres de cada cuatro) y tasas de extranjería prácticamente nulas. Conclusiones. Los titulados en medicina por la UB demostraron un alto rendimiento de estudio y se insertaron a la profesión en su entorno geográfico.

Reação de cultivares de feijoeiro comum à mancha angular em casa de vegetação

Foi avaliada a reação de 23 genótipos de feijoeiro comum (Phaseolus vulgaris) à mancha angular causada por Phaeoisariopsis griseola, utilizando os isolados monospóricos Ig 664 e Ig 669, caracterizados como os patótipos 63.23 e 63.19, respectivamente. Quatorze dias após a semeadura (estádio V3), as plantas foram inoculadas com uma suspensão contendo 2,5 x 10(4) conídios/mL, nas faces adaxial e abaxial da primeira folha trifoliolada. A avaliação dos sintomas foi efetuada aos 14 e 18 dias após a inoculação, utilizando-se uma escala variando de 1 (sem sintomas) a 9 ( > 25% da área foliar com lesões de mancha angular). Das cultivares analisadas, BRS Valente, CNFC 10281, CNFP 10138, BRS Grafite, BRS Requinte, BRS Pontal, MAR 02, Cornell 49-242 e AND 277 foram resistentes aos dois isolados. As cultivares Carioca Rubi, CNFC 9504, CNFC 10150 e Soberano foram suscetíveis aos dois patótipos testados. O patótipo 63.23 foi o mais virulento. As novas fontes de resistência à mancha angular identificadas neste trabalho podem ser utilizadas em programas de melhoramento do feijoeiro comum, que visem incorporar resistência em novas cultivares.

Line filter optimization in elevator use

The purpose of this thesis was to create design a guideline for an LCL-filter. This thesis reviews briefly the relevant harmonics standards, old filter designs and problems faced with the previous filters. This thesis proposes a modified design method based on the “Liserre’s method” presented in the literature. This modified method will take into account network parameters better. As input parameters, the method uses the nominal power, allowed ripple current in converter and network side and desired resonant frequency of the filter. Essential component selection issues for LCL-filter, such as heating, voltage strength, current rating etc. are also discussed. Furthermore, a simulation model used to verify the operation of the designed filter in nominal power use and in transient situations is included in this thesis.

Kylpylähotellin suorituskyvyn mittaaminen

Diplomityön tarkoituksena oli rakentaa suorituskyvyn analysointijärjestelmä kylpylä-hotellille. Kohdeyrityksessä on entuudestaan mitattu taloudellisia tunnuslukuja ja asiakastyytyväisyyttä. Rakennettu järjestelmä antaa yritykselle kokonaiskuvan suorituskyvystä. Valmiin analysointijärjestelmän avulla parannetaan yrityksen johtamista ja työn-tekijöille annettavaa palautetta. Tutkimuksen teoriaosassa esiteltiin suorituskyvyn mittaamiseen, suorituskyvyn analysointijärjestelmiin ja suorituskykymittariston suunnittelemiseen liittyvää teoriaa. Suorituskyvyn analysointijärjestelmän rakentaminen alkoi yrityksen vision ja strategioiden selkiyttämisellä, joiden pohjalta määritettiin menestystekijät ja kriittiset menestystekijät. Näiden taustatekijöiden avulla yritykselle luotiin Balanced Scorecardiin (BSC) pohjautuva suorituskyvyn analysointijärjestelmä. BSC:n näkökulmia sovellettiin hieman ja jokaiselle kehitettiin omat seurattavat mittarit. Kehitetty mittaristo vietiin pienille ja keskisuurille yrityksille tarkoitettuun SAKE-sovellukseen, joka laskee suorituskyvylle kokonaisarvosanan. Kylpylähotellin suorituskyvyn mittaamisessa on ennen kaikkea tärkeää huomioida asiakastyytyväisyys. Syy- ja seuraussuhteiden avulla kohdeyritykselle luotiin mittarit, joiden mittaamisella pyritään vaikuttamaan asiakastyytyväisyyteen ja sitä kautta parantamaan yrityksen toiminnan kannattavuutta sekä tehokkuutta. Tutkimuksen lopputulokseksi saatiin kylpylähotellille sopiva suorituskyvyn analysointijärjestelmä.

Soberania e exceção no pensamento de Carl Schmitt

O artigo procura demonstrar que ocorre, no pensamento de Carl Schmitt, a fusão entre a figura do legislador tal como tratada na Antigüidade e aquela do soberano moderno. Resulta disso que o conceito de exceção passa a ocupar o núcleo da vida política.

Nova interpretação da passagem 359d da República de Platão

Gyges foi o primeiro tirano a reinar na Lídia pela casa dos Mermenadae por volta do séc. VII a. C. Ele foi também o primeiro grande bárbaro com o qual os gregos estabeleceram contato. Seu caráter complexo fez com que se desenvolvessem diversas histórias a seu respeito, sendo a mais famosa aquela que conta a maneira como ele chegou ao poder. Sua fama percorreu o mundo grego e influenciou a poesia lírica de sua época e, posteriormente, a história, a filosofia e a retórica, principalmente no que diz respeito ao seu poder e riqueza. Em Platão, Gyges aparece ligado à narrativa de Glaúcon no Livro II da República (359b-360b), onde este conta os feitos daquele para se tornar o soberano da Lídia. No entanto, uma dificuldade na passagem 359d faz com a identificação direta de Gyges com a narrativa seja prejudicada. Pretendemos através deste trabalho apresentar algumas propostas para a passagem, utilizando-se para isso não só do texto de Platão como das fontes líricas e históricas anteriores a ele.